Last Updated: January 2023

Author: Diabetes Program, Vermont Department of Health

Kidneys are the organs responsible for removing waste and excess water from the body. End-stage renal disease (ESRD) is the last stage of chronic kidney disease and occurs when the kidneys are no longer able to meet the body’s needs for waste and water removal. Diabetes and poorly controlled high blood pressure are the most common causes of ESRD. About one out of two adults aged 30 - 64 is expected to develop chronic kidney disease during their lifetime. Learn more about chronic kidney disease from the CDC website.

The United States Renal Data System (USRDS), which is funded by the federal government, collects and analyzes information about ESRD. Rates of new cases (incidence) are reported per million in the population. Healthy Vermonters 2020 goals are to see this rate decline. Continued monitoring and prevention efforts that target diabetes and high blood pressure are needed to ensure this target continues to be met.

The rate of new cases of ESRD has been slowly declining nationally since 2006, but the national rate of 363 new cases per million in 2020 still exceeds the target rate of 344.3 new cases per million. See more detail from the United States Renal Data System. During 2008, a peak in Vermont of 248.3 cases of ESRD per million people was observed. The most recent values have all been below 220 per million people, indicating Vermont is moving in the right direction.

This indicator is part of Healthy Vermonters 2020 that documents the health status of Vermonters at the start of the decade and the population health indicators and goals that will guide the work of public health through 2020.

Progression to ESRD decreases quality of life, increases healthcare costs, and leads to premature death. The growing prevalence of childhood obesity leading to earlier onset of type 2 diabetes is expected to increase the incidence and prevalence of chronic kidney disease and the progression to ESRD at earlier ages during a person’s lifetime. Vermont’s observed decline in ESRD indicates success in preventing or delaying diabetes and success in management of those who already have diabetes and/or hypertension.

• Vermont Blueprint for Health
• University of Vermont Department of Medicine Nephrology Services 
• University of Vermont Medical Center Primary Care

Prevention of diabetes, effective management of blood sugars and blood pressures for those who already have diabetes, identifying people with high blood pressure who haven’t been diagnosed with hypertension, and effective management of blood pressure for those who have diagnosed hypertension are all important strategies to reduce the incidence of chronic kidney disease and its progression to ESRD. Read more about Chronic Kidney Disease from the National Institute of Diabetes and Digestive and Kidney Diseases.

At the Vermont Department of Health, staff in the Division of Health Promotion and Disease Prevention use Centers for Disease Control and Prevention (CDC) funds to collaborate with clinical partners in primary care. These partners help to identify Vermonters with diabetes risk, with diabetes that is poorly controlled, with high blood pressure that has not yet been diagnosed as hypertension, and with diagnosed hypertension that is poorly controlled and refer them to appropriate services.

Referral resources include evidence-based programs such as the National Diabetes Prevention Program and the Stanford-based Healthier Living Workshop for Diabetes. Other strategies include the development and distribution of treatment guidelines and consumer resources for clinical management and self-management of blood sugar and blood pressure. The Health Department has developed educational booklets for the DASH (Dietary Approaches to Stop Hypertension) diet and for managing diabetes – Learning to Live Well with Diabetes.

Incidence describes the number of new cases of a disease occurring during a specified time period and population. It is calculated by taking the number of identified new cases within the population divided by the total population size, multiplied by an arbitrary chosen multiplier (e.g. 1,000; 10,000, 1 million etc.) to express the incidence within that multiplier group. In this measure the rate is multiplied by 1 million to express the incidence per 1 million persons per year.

Incident cases of end-stage renal disease (ESRD) are extracted from the U.S. Renal Data System (USRDS). Extraction criteria for ESRD cases were new (incident) cases, occurring in Vermont, within a given calendar year for all ages, genders and race/ethnicities. Any incidence rates with a case count of 10 or fewer are suppressed. Denominator population data were taken from the Vermont Department of Health’s intercensal population estimates for the year being analyzed.

ESRD data is available only for patients whose ESRD therapy is reported to the USRDS, which comes from a variety of sources. Patients who expire before receiving treatment or whose therapy is not reported to the USRDS are not included. Please see the USRDS website for additional information on these data.