Public health surveillance of CKD: principles, steps, and challenges

Population-based surveillance of disease has become an important component of addressing such common chronic diseases as hypertension and diabetes. Such systems guide screening, prevention, and treatment resources. Development of a chronic kidney disease (CKD) surveillance system for the United States that focuses on early stages of CKD is an important activity that could help stem the increasing number of end-stage renal disease cases and CKD-related morbidity and mortality in the United States. It also could help in the evaluation of interventional programs that currently are being developed or already in place. Such a surveillance system should address the burden of CKD, awareness of CKD, CKD risk factors, CKD consequences, process and quality of care in CKD, and the health system capacity for CKD. It also should allow for estimations of the burden of CKD by age, sex, race/ethnicity, socioeconomic strata, geographic groups, and clinical subgroups. We describe the key components of a surveillance system for CKD, steps in the development of such a system, and challenges that need to be addressed. Information necessary for surveillance of CKD is evolving. At this juncture, collecting, integrating, analyzing, and interpreting information about CKD for surveillance by using a systematic, comprehensive, and feasible approach will be instrumental in prevention and health promotion efforts for this chronic disease.