End-stage Kidney Disease in the U.S. has doubled since 2000

 Kidney disease is on the rise in the U.S. Transplantation is the treatment of choice, but doesn't begin to meet the need.

JAMA has the story:

End-stage Kidney Disease Doubles  by Bridget M. Kuehn, MSJ, JAMA. 2022;327(16):1540. doi:10.1001/jama.2022.5342

"The number of people living with end-stage kidney disease (ESKD) more than doubled between 2000 and 2019—from 358 247 to 783 594—according to an analysis of data from the United States Renal Data System (USRDS). A 41.8% increase in new cases also occurred during the study period, from 92 660 cases to 131 422 cases. Hypertension and diabetes were driving factors.

"Substantial racial and ethnic disparities in ESKD rates remain a concern. Among Asian people, new ESKD cases increased from 2507 cases in 2000 to 6256 cases in 2019—a 149.5% increase that was the largest in any racial or ethnic group. During the study period, new cases increased from 25 917 to 33 700 among Black people, from 11 297 to 20 790 among Hispanic people, from 742 to 1458 among Native Hawaiian or other Pacific Islander people, and from 51 156 to 67 919 among White people.

...

"They note that in 2019 alone, Medicare spent $37.3 billion or 7% of all claims on ESKD, according to USRDS data."

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Update: Here's the USRDS 2021 Annual Data Report, and 

here's End Stage Renal Disease: Chapter 1: Incidence, Prevalence, Patient Characteristics, and Treatment Modalities

Highlights:

• In 2019, 134,608 individuals were newly diagnosed with end-stage renal disease (ESRD), representing an increase of 2.7% from the previous year and 15.8% from a decade ago (Figure 1.1). However, the adjusted incidence fell from a peak of 431 per million population (pmp) in 2006 to 386 pmp in 2019.
• In 2019, 85% of those with incident ESRD initiated in-center hemodialysis (HD) (Figure 1.2). This represents a decrease from 91% in 2009. Over the past decade, the percentage initiating kidney replacement therapy with peritoneal dialysis (PD) nearly doubled, from 6% to 11%. The percentage who received a preemptive kidney transplant remained unchanged over the decade at about 3%.
• Adjusted ESRD incidence increased as age increased: among individuals aged 0-17 years, the adjusted incidence in 2019 was 12 pmp; among individuals aged 65-74 years, 1,307 pmp; and among individuals aged ≥75 years 1,587 pmp (Figure 1.4).
• Between 2009 and 2019, adjusted ESRD incidence in Black individuals decreased by 17.5%, in Native American individuals by 14.1%, in Hispanic individuals by 12.1%, in Asian individuals by 5.2%, and in White individuals by 2.4% (Figure 1.4). However, in all individuals except for Whites, adjusted incidence increased between 2018 and 2019.
• The prevalent count of individuals with ESRD reached 809,103 in 2019, an increase of 41.0% from 2009 (Figure 1.5). Adjusted ESRD prevalence also increased to an all-time high of 2302 cases pmp in 2019. 
• At the end of 2019, 492,096 individuals were receiving in-center HD, up 1.7% from 2018 and 34.5% from 2009 (Figure 1.6). There were 12,243 patients performing home HD at year’s end, an increase of 20.1% over the preceding year. The number of individuals receiving PD increased to 62,275, representing 8.5% growth in a single year.
• Adjusted ESRD prevalence in Black individuals was far higher, at 6423 pmp, than in other racial and ethnic groups; adjusted prevalence in Black individuals was 78.6% higher than in the next-highest group, Native Americans, and more than fourfold higher than in White individuals (Figure 1.8).
• The percentage of patients with prevalent ESRD who had a functioning kidney transplant was highest among White (36%) and lowest among Native Hawaiian and Pacific Islander (18%) individuals. Conversely, White individuals had the lowest percentage receiving in-center HD (54%), and Native Hawaiian and Pacific Islander individuals had the highest (73%) (Figure 1.10).
• White (73%), Asian (72%), and Native American (72%) individuals were much more likely to have received pre-ESRD care compared with Black (64%), Native Hawaiian/Pacific Islander (62%), and Hispanic (61%) individuals (Figure 1.11). 
• In 2019, 39% of patients had an estimated glomerular filtration rate (eGFR) ≥10 mL/min/1.73 m² at ESRD onset (Figure 1.14). The mean eGFR at initiation of kidney replacement therapy was 9.6 mL/min/1.73m2 (Table 1.3). Overall, 60.6% of incident patients with ESRD had diabetes mellitus (DM), 28.4% heart failure (HF), and 20.8% other cardiac disease (Figure 1.18). Fully 77.5% of Native American individuals had DM, compared with 57.8% of White individuals.
• Cardiovascular disease (CVD) was present in 77.3% of patients receiving HD, 66.4% of patients receiving PD, and 54.8% of patients with a kidney transplant.