2006 Georgia data summary: kidney disease

2006 Georgia Data Summary:
KIDNEY DISEASE

Kidney disease is a leading cause of death and medical expenditure in Georgia.

WHAT IS KIDNEY DISEASE?
The term "kidney disease" or "renal disease" refers to a partial or complete loss of kidney function, which may lead to heart disease, bone disease, anemia, and nerve damage, or even premature death.
If detected early, the progression of kidney disease and its complications can be delayed. Unfortunately, mild loss of kidney function has no symptoms.
In contrast, severe kidney function loss can have a broad range of symptoms: weakness; shortness of breath; swelling of the hands, feet, or face; difficulty in concentration; loss of appetite; and nausea.
Certain types of kidney disease, if untreated, can cause progressive loss of kidney function and eventually kidney failure. Persons with kidney failure cannot survive without receiving dialysis or a transplant; this irreversible, terminal condition is called end-stage renal disease (ESRD).
VITAL FUNCTIONS OF THE KIDNEYS
The kidneys regulate the fluid and electrolytes balance; control acid-base balance; remove excess water, waste and toxic products from the body; have a role in the synthesis of red blood cells; and maintain and keep blood pressure within the normal range.
Many factors such as infections, chemicals, metabolic disorders, mechanical causes, and genetic conditions can impair kidney function. Among them, diabetes and high blood pressure are the two most common causes of kidney damage.

Kidney Disease in Georgia (2003)
A common, serious, and costly chronic disease
The ninth leading cause of death, accounting for 1,475 deaths, equivalent to four deaths every day
The age-adjusted death rate -- 21.7 deaths per 100,000 population (about 49% higher than the U.S. rate of 14.6)
Risk of dying from kidney disease -- Males were 1.3 times more likely than females. Blacks were 2.6 times more likely than whites.
Premature death (before age 65) -- Blacks were 1.7 times more likely than whites.

Leading causes of death Georgia (2003)

Heart disease Cancer Stroke
Unintentional injuries CLRD
Diabetes Influenza & pneumonia
Alzheimer's disease Kidney disease Septicemia Suicide Hypertension

4,285 3,466 3,241 1,720 1,679 1,632 1,475 1,343 961 894

17,180 13,997

0

5,000 10,000 15,000 20,000

Number of deaths

Note. CLRD = chronic lower respiratory disease

Georgia Department of Human Resources, Division of Public Health 2 Peachtree Street, NW Atlanta, GA 30303 (404) 657-3103 gdphinfo@dhr.state.ga.us http://health.state.ga.us

Deaths per 100,000 population

MORTALITY FROM KIDNEY DISEASE
Kidney disease is a common, serious, and costly chronic disease in Georgia as well as in the United States.

Age-adjusted kidney disease death rates by race and sex, Georgia (1999-2003)

50

44.5

40

37.8

In 2003, kidney disease was the ninth leading cause of death in Georgia, accounting for 1,475 deaths. The age-adjusted death rate* for kidney diseases (nephritis, nephrotic syndrome, and nephrosis) in Georgia during 1999 through 2003 was 20.3 deaths per 100,000 population.
The age-adjusted death rate of kidney disease in Georgia has been consistently higher than that of the United States. From 1999 through 2003, the difference became greater. The sudden increase in rates in 1999 for both Georgia and the United States was due to a change in the coding scheme (from ICD-9 to ICD-10).
Age-adjusted kidney disease death rates Georgia vs. United States (1991-2003)

30

19.4

20

13.0

10

0 Black Male

Black Female

White Male

White Female

Death rates due to kidney disease were highest among older Georgians. The age-specific death rate for kidney disease increased from 2.2 per 100,000 for persons under 55 years of age to 378.0 per 100,000 for persons aged 85 years and older, an increase of more than 170-fold.

Age-specific kidney disease death rates

Georgia (1999-2003)

400

378.0

Deaths per 100,000 population

Deaths per 100,000 population

25

GA

U.S.

20

15

10

5

0 91 92 93 94 95 96 97 98 99 00 01 02 03 Year

In Georgia, age-adjusted death rates of kidney disease from 1999 through 2003 were higher for males (24.0 per 100,000) than for females (18.4 per 100,000); and higher for blacks (40.2 per 100,000) than for whites (15.3 per 100,000).
During the same period, the age-adjusted death rate for black males (44.5 per 100,000) was more than two times higher than for white males (19.4 per 100,000), and the age-adjusted death rate for black females (37.8 per 100,000) was almost three times higher than for white females (13.0 per 100,000).

300

200

152.1

100
2.2 0

61.7 21.5

Under 55 55 to 64 65 to 74 75 to 84

Age Group (in years)

85 & Above

Of the 6,612 deaths from kidney disease in Georgia during 1999 through 2003, 1,492 deaths (23%) occurred in people less than 65 years of age. The proportion of deaths before age 65 (premature death) was highest for black males.

Premature deaths from kidney disease by race and sex, Georgia (2003)
40 37.6

30

24.2

22.0

20

14.2

10

Percent of total deaths in a given race-sex group

* Age adjustment is used to compare risk of two or more populations at one point in time or one population at two or more points in time. Age-adjusted rates are computed by the direct method based on the year 2000 projected U.S. standard population.

0

Black Male

Black Female

White Male

White Female

Georgia Department of Human Resources, Division of Public Health 2 Peachtree Street, NW Atlanta, GA 30303 (404) 657-3103 gdphinfo@dhr.state.ga.us http://health.state.ga.us

INCIDENCE AND PREVALENCE OF ESRD
The age-adjusted incidence* of ESRD in both Georgia and the United States has steadily increased since 1980; the average annual increase was more than 6% in both regions. The incidence rate in Georgia has been consistently higher than the national rate, and the gap has increased over time. In 2002, the annual ESRD incidence rates per 100,000 population were 44 for Georgia and 35 for the United States.

End-Stage Renal Disease in Georgia (2002)
The age-adjusted incidence rate -- 44 per 100,000 population (consistently higher than the U.S. since 1980)
Number of patients with ESRD -- 14,600
The estimated cost of health care for ESRD patients -- Approximately $905 million

In Georgia, the age-adjusted incidence rate for ESRD in 2002 was higher for males (51.0 per 100,000) than for females (38.9 per 100,000); and higher for blacks (107.9 per 100,000) than for whites (24.8 per 100,000). The incidence rate for black males (121.6 per 100,000) was four times higher than for white males (31.3 per 100,000), and the incidence rate for black females (97.6 per 100,000) was about five times higher than for white females (20.5 per 100,000).
In Georgia, the age-adjusted prevalence** of ESRD has increased since 1980 as its incidence rate went up steadily. The number of Georgians living with ESRD is growing faster than the incidence of ESRD because more people acquire the disease every year than die from it.

The primary causes of ESRD -- Diabetes (accounted for 43% of cases) High blood pressure (contributed to 33% of cases)
Risk of developing to ESRD -- Males are 1.3 times more likely than females. Blacks are 4.3 times more likely than whites.
GEORGIA COUNTIES' PROFILE The age-adjusted prevalence rate, incidence rate, and death rate for kidney disease differ from county to county in Georgia.

Age-adjusted prevalence and incidence rates for ESRD in Georgia (1991-2002)

200

Prevalence

Incidence

150

Deaths per 100,000 population

100

50
0 91 92 93 94 95 96 97 98 99 00 01 02 Year
In 2002, approximately 14,600 people in Georgia had ESRD. With an average cost of $62,000 per dialysis patient per year, the total health care cost of ESRD for Georgia in 2002 was estimated at $905 million.
* Incidence is the number of new cases of ESRD per 100,000 population in a certain time period, usually a year. ** Prevalence is the number of existing cases of ESRD per 100,000 population at a specific point in time, no matter how long the person has had ESRD.

In 2002, Oconee County had the lowest prevalence rate for ESRD (62 per 100,000), and Terrell County had the highest prevalence rate (569 per 100,000). North Georgia counties were more likely to have lower prevalence of ESRD compared to the state, while many counties in the Southwest and the Mid-eastern part of Georgia had significantly higher prevalence of ESRD than the state.
Regarding the age-adjusted incidence rate for ESRD, White County had the lowest (18 per 100,000) and Dooly County had the highest (112 per 100,000).

Georgia Department of Human Resources, Division of Public Health 2 Peachtree Street, NW Atlanta, GA 30303 (404) 657-3103 gdphinfo@dhr.state.ga.us http://health.state.ga.us

The age-adjusted death rate per 100,000 population ranged from 8.4 in Madison County to 50 in Hancock County.
PREVENTION OF ESRD

In addition to about 14,000 Stage 5 CKD or ESRD patients in Georgia in 2000, the National Kidney Foundation of Georgia estimated that there were approximately 884,000 Georgians living with CKD of Stages 1 through 4.

Adverse outcomes of chronic kidney disease can often be prevented or delayed through early detection and treatment. Earlier stages of chronic kidney disease can be detected through routine laboratory examinations.

Get Tested to Know Glomerular Filtration Rate
According to the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative Clinical Practice Guidelines for Chronic Kidney Disease (CKD), there are five stages of CKD based on a person's glomerular filtration rate (GFR). GFR indicates how fast the kidneys filter waste from one's blood and can be estimated based on a person's blood creatinine level, height, weight, sex, race, and age.

Each stage of CKD includes a range of GFRs. The lower the GFR, the weaker the kidneys' ability to filter waste from one's blood, and the higher the severity of CKD. Persons with GFR less than 15 are in Stage 5, and they are considered to have kidney failure or complete loss of kidney function. Persons in this category are diagnosed with ESRD, and their survival depends on dialysis or kidney transplantation.

Stages of chronic kidney disease and estimated number of Georgians with chronic kidney disease, Georgia (2000)

Stage
1
2 3 4 5

GFR1
90
60-89 30-59 15-29 <15 or on dialysis

Description
Kidney damage3 with normal or an in GFR Kidney damage with a mild in GFR Moderate in GFR Severe in GFR Kidney Failure

Estimated cases2 270,000
246,000
352,000 16,000 14,000

1 = measured in mL/min/1.73 m2 2 = based on the 2000 Georgia population estimates and the NHANES III results. 3 = kidney damage is defined as the presence of pathologic abnormalities or makers of
damage, including abnormalities in blood or urine tests or imaging studies.

Preventing Common Risk Factors for ESRD
Diabetes and high blood pressure are the two most common causes of ESRD. Physicians in Georgia reported that there were 3,302 newly diagnosed ESRD patients in 2002. Of them, 76% had either diabetes (43%) or high blood pressure (33%).
Primary causes of ESRD Georgia (2002)

Other Causes
24%
High Blood Pressure 33%

Diabetes 43%

For many people, maintaining a normal body weight and being physically active can prevent diabetes and high blood pressure. Even if they do occur, they can be controlled by modifying lifestyles and by the use of appropriate medications. Preventing and controlling these two modifiable conditions will greatly reduce the risk of developing ESRD.
People living with either disease should monitor their blood pressure, blood sugar levels, or both on a regular basis. They should also adhere to medications prescribed by their physician. Individuals with a family history of kidney disease or ESRD should also see their physician for periodic evaluation.
Date published: September 2006 Publication Number: DPH06.137HW
Note. The content of this data summary is adapted from the 2005 Kidney Disease in Georgia Report (www.health.state.ga.us/epi/cdiee/diabetes.asp).

The People At Risk. The Power To Prevent.

National Kidney Foundation of Georgia

Georgia Department of Human Resources, Division of Public Health 2 Peachtree Street, NW Atlanta, GA 30303 (404) 657-3103 gdphinfo@dhr.state.ga.us http://health.state.ga.us