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USRDS Releases 2021 Interactive Annual Data Report

The Chronic Disease Research Group (CDRG), in partnership with the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), is proud to announce the release of the 2021 USRDS Annual Data Report (ADR).

The report is again presented in a fully interactive format, which was introduced with the 2020 ADR. However, the content has been improved, restructured, and expanded. Building on the COVID-19 Supplement (coronavirus disease 2019) introduced in the 2020 ADR, the ADR’s critical surveillance mission continues by including an updated COVID-19 Supplement that presents many outcomes through the end of 2020 and some through the second quarter of 2021. Quarterly claims data from payment year 2020 is utilized to describe COVID testing and cases, incidence of COVID-related AKI, utilization of therapeutic interventions (e.g., hospitalization, ICU care, mechanical ventilation), and post-discharge outcomes in COVID survivors.

The COVID pandemic had a significant impact on the ESRD population. The cumulative incidence rate of COVID-19 was twice as high among dialysis patients as among the general population. COVID-19 incidence was also higher for the CKD and transplant populations. As a result, total deaths in the dialysis population increased by nearly 18,000 in 2020 compared with 2019, an increase of almost 20 percent.  Also, reduced rates of initiation of kidney replacement therapy in the early wave of the pandemic resulted in almost 5,000 fewer cases of treated ESRD for the entire year. As a result, the dialysis population had an unprecedented decline of 2 percent due to the COVID-19 pandemic.

Additional updates with the release of this report include:

  • A new chapter on racial and ethnic disparities in healthcare delivery and outcomes in the CKD and ESRD populations.
  • A new chapter on home dialysis.
  • Elimination of the chapters dedicated to cardiovascular disease, dispersing much of their content into the relevant remaining chapters.

This year’s ADR also includes new or reintroduced sources of data:

  • Optum® de-identified Clinformatics® Data Mart database.
  • CMS Medicaid T-MSIS Analytic Files.
  • ESRD Quality Reporting System (EQRS) data.
  • Medicare Provider Analysis and Review (MedPAR) data.

To learn more about these data sources, read the 2021 ADR introductory chapter.

Based on the data in this year’s ADR, the last decade was marked by substantial improvement in several important metrics and clinical outcomes among individuals with CKD and ESRD. Among others, these include:

CKD outcomes

  • A 22% reduction in adjusted all-cause mortality among Medicare fee-for-service (FFS) beneficiaries ≥66 years of age with CKD that was more than twice as large as the reduction in mortality observed among beneficiaries without CKD.
  • A 29% reduction in the adjusted rate of all-cause hospitalization among Medicare FFS beneficiaries aged 66 years or older with CKD.
  • A 14% reduction in readmission after hospital discharge among older Medicare FFS beneficiaries with CKD.

ESRD outcomes

  • An increase in the percentage of older Medicare beneficiaries with prior CKD initiating dialysis outside of the hospital since 2014, reaching almost 60%.
  • A 7% reduction in adjusted ESRD incidence to 373 per million population in 2019.
  • A 25% reduction in the percentage of patients initiating dialysis with eGFR ≥15 ml/min/1.73m2.
  • An 85% increase in the percentage of incident dialysis patients starting home dialysis, and a 73% increase in the percentage of patients performing home dialysis one year after dialysis initiation.
  • A 61% reduction in the rate of hospitalization for peritonitis and a 36% reduction in the rate of hospitalization for catheter complications among patients performing peritoneal dialysis.
  • A 13% reduction in adjusted rate of all-cause hospitalization among prevalent hemodialysis patients, 14% reduction among prevalent peritoneal dialysis patients, and 11% reduction among kidney transplant recipients. Reductions in the rate of all-cause hospitalization in the first year after dialysis initiation were even larger at 18% for patients treated with hemodialysis and 20% among those performing peritoneal dialysis.
  • A 17.5% reduction in adjusted all-cause mortality among patients on hemodialysis and a 21% reduction among patients performing peritoneal dialysis.
  • Increase in the rate of kidney transplantation among patients with ESRD that began in the second half of the decade – a reversal that followed a period of decline during the first half of the decade.

The USRDS serves the kidney community through research, analysis, and investigator-initiated research. If you have any questions about the 2021 ADR, please Contact USRDS

About the USRDS

The core purpose of the USRDS ADR is to characterize the impact of chronic kidney disease on the US population and to support research and policy initiatives designed to improve the care of individuals with kidney disease. The new report features data accumulated through 2018. Along with producing the ADR on end-stage renal disease and chronic kidney disease in the United States, the USRDS fulfills data requests, provides standard analysis files (SAFs) to researchers, produces the Researcher’s Guide to help researchers use USRDS data, and presents the results of its research at national conferences and in peer-reviewed journals. Learn more by visiting the About USRDS website.


NIDDK research creates knowledge about and treatments for diseases that are among the most chronic, costly, and consequential for patients, their families, and the nation. Learn more About NIDDK.

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