title: Geographic variation in CKD prevalence and ESRD incidence in the United States: results from the reasons for geographic and racial differences in stroke (REGARDS) study.
abstract: BACKGROUND
  It is not known whether geographic differences in the prevalence of chronic kidney disease exist and are associated with end-stage renal disease (ESRD) incidence rates across the United States.
  
  
  METHODS
  Cross-sectional and ecologic.
  
  
  METHODS
  White (n = 16,410) and black (n = 11,109) participants from across the continental United States in the population-based Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study.
  
  
  METHODS
  Geographic region, defined by the 18 networks of the US ESRD Network Program.
  
  
  METHODS
  Albuminuria, defined as albumin-creatinine ratio ≥30 mg/g, and decreased estimated glomerular filtration rate (eGFR), defined as <60 mL/min/1.73 m(2), were measured in the REGARDS Study. ESRD incidence rates were obtained from the US Renal Data System.
  
  
  RESULTS
  For whites, the network-specific prevalence of albuminuria ranged from 8.4% (95% CI, 3.3%-13.5%) in Network 15 to 14.8% (95% CI, 8.0%-21.6%) in Network 3, and decreased eGFR ranged from 4.3% (95% CI, 2.0%-6.6%) in Network 4 to 16.7% (95% CI, 12.7%-20.7%) in Network 7. For blacks, the prevalence of albuminuria ranged from 12.1% (95% CI, 8.7%-15.5%) in Network 5 to 26.5% (95% CI, 16.7%-36.3%) in Network 4, and decreased eGFR ranged from 6.7% (95% CI, 5.0%-8.4%) in Network 17/18 to 13.4% (95% CI, 7.8%-19.1%) in Network 12. Spearman correlation coefficients for the prevalence of albuminuria and decreased eGFR with network-specific ESRD incidence rates were 0.49 and 0.24, respectively, for whites and 0.29 and 0.25, respectively, for blacks.
  
  
  CONCLUSIONS
  There were few cases of albuminuria and decreased eGFR in some geographic regions.
  
  
  CONCLUSIONS
  In the United States, substantial geographic variations in the prevalence of albuminuria and decreased eGFR exist, but were correlated only modestly with ESRD incidence, suggesting the chronic kidney disease burden may not explain the geographic variation in ESRD incidence.
authors.affiliation: University of Alabama at Birmingham, Birmingham, AL 35294, USA.
authors.forename: Rikki M
authors.initials: RM
authors.lastname: Tanner
authors.forename: Orlando M
authors.initials: OM
authors.lastname: Gutiérrez
authors.forename: Suzanne
authors.initials: S
authors.lastname: Judd
authors.forename: William
authors.initials: W
authors.lastname: McClellan
authors.forename: C Barrett
authors.initials: CB
authors.lastname: Bowling
authors.forename: Brian D
authors.initials: BD
authors.lastname: Bradbury
authors.forename: Monika M
authors.initials: MM
authors.lastname: Safford
authors.forename: Mary
authors.initials: M
authors.lastname: Cushman
authors.forename: David
authors.initials: D
authors.lastname: Warnock
authors.forename: Paul
authors.initials: P
authors.lastname: Muntner
mesh_terms: D001741:Black or African American; D000368:Aged; D000419:Albuminuria / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology; D003430:Cross-Sectional Studies; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000453:epidemiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000453:epidemiology* / Q000503:physiopathology; D020521:Stroke / Q000150:complications* / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D044465:White People