Causes and Consequences of Chronic Kidney Disease: Implications for Managed Health Care

BACKGROUND: Chronic kidney disease (CKD) is a major public health problem that often goes unrecognized until late-stage disease. In the United States, nearly 20 million people have CKD, and this number is likely to grow as the population ages and the prevalence of diabetes and hypertension rises. With $28 billion currently spent on end-stage renal disease care in the United States and with the rapidly expanding dialysis population, it is essential to actively address this epidemic, both by reducing the number of patients who reach kidney failure and by decreasing morbidity and mortality among those with early-stage CKD. OBJECTIVES: To review the burden of CKD and its comorbidities on patients, physicians, and payers and discuss the potential benefits to individual patients and society of identifying and treating earlier stages of CKD. CONCLUSIONS: Major steps in dealing with the CKD epidemic are (1) identifying individuals at risk for and with earlier stages of CKD, (2) initiating therapies to slow progression of kidney disease, and (3) treating comorbid conditions associated with CKD, including cardiovascular disease and anemia.