Chapter 5 «» Chronic kidney disease s57

p r e v a l e n c e o f C K D & f a m i l y h i s t o r y o f

k i d n e y d i s e a s e

h y p e r t e n s i o n

d i a b e t e s

o b e s i t y

s m o k i n g

C K D r i s k f a c t o r s

m i c r o a l b u m i n u r i a & a l b u m i n / c r e a t i n i n e

r a t i o

P T H , c a l c i u m , & p h o s p h o r u s

Ch ro n ic k id n e y d i se a se

“I was found to have proteinuria. My regular doctor sees me every 3 months for my high blood pressure..., but he sent me to a nephrologist who put me on an additional medicine…. My protein went from 200 to 6 on the new medication! He follows me every 6 months and yearly with urine and blood work. I’m glad I got screened! Keep up the good work!”

KEEP participant: Screening date, November, 2005

5

National Kidney Foundation «» Kidney Early Evaluation Program «» 2006 s58

prevalence of ckd & family history of kidney disease

All <60

≥60

e n i n i t a e r c d e t a v e l e h t i w

t n e c r e P 0

4

8

12

16

20

18-30 31-45

46-60 61-75

75+ White Black

Nat Am Asian

Pac Isl Other

Age Age Race

All 18-30

31-45 46-60

61-75 75+

D

K C

h t i

w

t n e c r e P

0

20

40

60

80 KEEP NHANES 99-02

M F W B Oth Hisp

Age Gender Race/ethnicity

All CKD Stage 1 Stage 2 Stage 3 Stage 4-5

D

K C

h t i

w

t n e c r e P

0

20

40

60 Old CKD staging definition New CKD staging definition

All CKD NCKD CKD+DM CKD+ CKD+DM CKD+Oth +HTN +HTN

Perc

ent o

f par

ticip

ants

0

25

50

75

100

<HS+NINS <HS+INS

≥HS+NINS ≥HS+INS

<HS+NINS <HS+INS

≥HS+NINS ≥HS+INS

D

K C

h t i

w

t n e c r e P

0

20

40

60 White Black Other Hispanic

Age Race/ethnicity

KEEP NHANES 99-02

18-45 46-60 61+

All <60

≥60

e n i n i t a e r c d e t a v e l e h t i w

t n e c r e P 0

4

8

12

16

20

18-30 31-45

46-60 61-75

75+ White Black

Nat Am Asian

Pac Isl Other

Age Age Race

All 18-30

31-45 46-60

61-75 75+

D

K C

h t i

w

t n e c r e P

0

20

40

60

80 KEEP NHANES 99-02

M F W B Oth Hisp

Age Gender Race/ethnicity

All CKD Stage 1 Stage 2 Stage 3 Stage 4-5

D

K C

h t i

w

t n e c r e P

0

20

40

60 Old CKD staging definition New CKD staging definition

All CKD NCKD CKD+DM CKD+ CKD+DM CKD+Oth +HTN +HTN

Perc

ent o

f par

ticip

ants

0

25

50

75

100

<HS+NINS <HS+INS

≥HS+NINS ≥HS+INS

<HS+NINS <HS+INS

≥HS+NINS ≥HS+INS

D

K C

h t i

w

t n e c r e P

0

20

40

60 White Black Other Hispanic

Age Race/ethnicity

KEEP NHANES 99-02

18-45 46-60 61+

All <60

≥60

e n i n i t a e r c d e t a v e l e h t i w

t n e c r e P 0

4

8

12

16

20

18-30 31-45

46-60 61-75

75+ White Black

Nat Am Asian

Pac Isl Other

Age Age Race

All 18-30

31-45 46-60

61-75 75+

D

K C

h t i

w

t n e c r e P

0

20

40

60

80 KEEP NHANES 99-02

M F W B Oth Hisp

Age Gender Race/ethnicity

All CKD Stage 1 Stage 2 Stage 3 Stage 4-5

D

K C

h t i

w

t n e c r e P

0

20

40

60 Old CKD staging definition New CKD staging definition

All CKD NCKD CKD+DM CKD+ CKD+DM CKD+Oth +HTN +HTN

Perc

ent o

f par

ticip

ants

0

25

50

75

100

<HS+NINS <HS+INS

≥HS+NINS ≥HS+INS

<HS+NINS <HS+INS

≥HS+NINS ≥HS+INS

D

K C

h t i

w

t n e c r e P

0

20

40

60 White Black Other Hispanic

Age Race/ethnicity

KEEP NHANES 99-02

18-45 46-60 61+

5.1

Elevated serum creatinine levels in KEEP participants, overall & by age, and raceKEEP N = 52,892.

5.2

CKD in KEEP & NHANES participants, by age, gender, & race ethnicityKEEP N = 45,311, age & gender; 44,400, race. NHANES N = 9,718.

5.3

CKD in KEEP participants, by CKD stage & CKD definitionKEEP N = 45,311.

5.4

Interactions of CKD, diabetes, & hypertension in KEEP & NHANES participants KEEP N = 44,925. NHANES N = 9,599.

5.5

KEEP participants with CKD, by education & insurance status, age, & race/ethnicity KEEP N = 43,008, age; 42,240, race/ethnicity.

Chapter 5 «» Chronic kidney disease s59

All Male Female

DK fo yrot sih ylimaf a hti

w % 0

10

20

30

White Black N Am Asian Pac Isl Other

DK fo yrotsih ylimaf a hti

w tn ecreP

0

10

20

30

Non-Hisp Mexico Puerto Rico Cuban Oth Hisp

DK fo yrotsih ylimaf a hti

w tnecreP

0

10

20

30

All Male Female

DK fo yrot sih ylimaf a hti

w % 0

10

20

30

White Black N Am Asian Pac Isl Other

DK fo yrotsih ylimaf a hti

w tn ecreP

0

10

20

30

Non-Hisp Mexico Puerto Rico Cuban Oth Hisp

DK fo yrotsih ylimaf a hti

w tnecreP

0

10

20

30

5.6

Family history of kidney disease in KEEP participants with CKD, overall & by genderKEEP N = 12,407.

5.8

Family history of kidney disease in KEEP participants with CKD, by Hispanic ethnicityKEEP N = 12,407.

5.7

Family history of kidney disease in KEEP participants with CKD, by raceKEEP N = 12,407.

f left untreated, chronic kid-ney disease (CKD) can lead to end-stage renal disease (ESRD). In 2002, the National Kidney Foundation published guide-lines defining the severity of

kidney damage through a five-stage classification system based on estimat-ed glomerular filtration rates (eGFRs) and the presence of urine microalbu-min. This system defined CKD by an eGFR (K/DOQI MDRD) less than 60 ml/min/1.73 m2, or an eGFR (K/DOQI MDRD) ≥60 ml/min/1.73 m2 in the presence of microalbuminuria. The defi-nition has recently been modified, and for microalbumin substitutes an albu-min/creatinine ratio ≥30 mg/g.

Slightly more than 5% of KEEP partici-pants—16 percent of those age 75 and

older—have elevated serum creatinine levels. Using the new CKD definition, 29% percent have CKD compared to 57% when using the old definition.

Among KEEP participants, CKD is evenly distributed between males and females, and occurs most frequently in whites. Twenty-two percent of KEEP participants with CKD have a family his-tory of kidney disease—18.6% of males and 23.1% of females. A family history of kidney disease in KEEP participants with CKD is found in 26.5% of Native Americans and 24% of blacks, compared to 15% of Asians. Among Hispanic KEEP participants with CKD, 26 and 23% of those with Mexican or Puerto Rican heri-tage, respectively, have a family history of kidney disease.

National Kidney Foundation «» Kidney Early Evaluation Program «» 2006 s60

hypertension

Normal: 14.2

Prehypertension: 35.6

Stage 1: 30.6

Normal: 34.3

Stage 1: 17.4

Prehypertension: 36.9

Normal: 20.8

Prehypertension: 41.3

Stage 1: 26.6

Normal:46.0

S e

g a t

1 :

1 2 6 .

Prehypertension: 36.9

Stage 2: 19.6

KEEP: CKD NHANES 99-02: CKD

Stage 2: 11.5

Stage 2: 11.2

KEEP: No CKD NHANES 99-02: No CKD

Stage 2: 4.5

All 18-30

31-45 46-60

61-75 75+

0

20

40

60

80

100

N

T H

d e t r o p e r - f l e s h t i

w

t n e c r e P

0

20

40

60

80

100

CKD No CKD

KEEP Gender Race/ethnicity

Male Female

White Black

Other Hisp.

NHANES 99-02

*

0

20

40

60

80

100

120

140

160

Non-CKD Stage 1 Stage 2 Stage 3 Stages 4-5 0

20

40

60

80

100

120

140

160

) g H

m

m

( e r u s s e r p d o o l B

KEEP

NHANES 99-02

systolic

diastolic

mean

pulse pressure (systolic-diastolic)

pulse pressure (systolic-diastolic)

systolic

mean

diastolic

Normal: 14.2

Prehypertension: 35.6

Stage 1: 30.6

Normal: 34.3

Stage 1: 17.4

Prehypertension: 36.9

Normal: 20.8

Prehypertension: 41.3

Stage 1: 26.6

Normal:46.0

S e

g a t

1 :

1 2 6 .

Prehypertension: 36.9

Stage 2: 19.6

KEEP: CKD NHANES 99-02: CKD

Stage 2: 11.5

Stage 2: 11.2

KEEP: No CKD NHANES 99-02: No CKD

Stage 2: 4.5

All 18-30

31-45 46-60

61-75 75+

0

20

40

60

80

100

N

T H

d e t r o p e r - f l e s h t i

w

t n e c r e P

0

20

40

60

80

100

CKD No CKD

KEEP Gender Race/ethnicity

Male Female

White Black

Other Hisp.

NHANES 99-02

*

0

20

40

60

80

100

120

140

160

Non-CKD Stage 1 Stage 2 Stage 3 Stages 4-5 0

20

40

60

80

100

120

140

160

) g H

m

m

( e r u s s e r p d o o l B

KEEP

NHANES 99-02

systolic

diastolic

mean

pulse pressure (systolic-diastolic)

pulse pressure (systolic-diastolic)

systolic

mean

diastolic

Normal: 14.2

Prehypertension: 35.6

Stage 1: 30.6

Normal: 34.3

Stage 1: 17.4

Prehypertension: 36.9

Normal: 20.8

Prehypertension: 41.3

Stage 1: 26.6

Normal:46.0

S e

g a t

1 :

1 2 6 .

Prehypertension: 36.9

Stage 2: 19.6

KEEP: CKD NHANES 99-02: CKD

Stage 2: 11.5

Stage 2: 11.2

KEEP: No CKD NHANES 99-02: No CKD

Stage 2: 4.5

All 18-30

31-45 46-60

61-75 75+

0

20

40

60

80

100

N

T H

d e t r o p e r - f l e s h t i

w

t n e c r e P

0

20

40

60

80

100

CKD No CKD

KEEP Gender Race/ethnicity

Male Female

White Black

Other Hisp.

NHANES 99-02

*

0

20

40

60

80

100

120

140

160

Non-CKD Stage 1 Stage 2 Stage 3 Stages 4-5 0

20

40

60

80

100

120

140

160

) g H

m

m

( e r u s s e r p d o o l B

KEEP

NHANES 99-02

systolic

diastolic

mean

pulse pressure (systolic-diastolic)

pulse pressure (systolic-diastolic)

systolic

mean

diastolic

All non-CKD Stage 1 Stage 2 Stage 3 Stage 4-5

erusserp doolb detave le htiw

% 0

20

40

60

80

All non-CKD Stage 1 Stage 2 Stage 3 Stage 4-5erusserp doolb tegrat gnitee

m %

0

20

40

60

80

erusserp doolb detavele htiw tne creP

0

20

40

60

80

100CKDNo CKD

KEEP: Age Gender Race/ethnicity

0

20

40

60

80

100 NHANES 99-02

KEEP NHANES 99-02

All18-30

31-4546-60

61-7575+

MaleFemale

WhiteBlack

OtherHisp.

KEEP NHANES 99-02

5.9

Percent distribution by hypertension stage (JNC 7) in KEEP & NHANES participants with or without CKDKEEP N = 44,673. NHANES N = 9,400.

5.10

Self-reported hypertension in KEEP & NHANES participants with or without CKD, by age, gender, & race/ethnicityKEEP N = 12,573, CKD; 31,284, no CKD. NHANES N = 1,495, CKD; 8,106, no CKD. *Sample size less than 30 or coefficient of variation not less than 30%.

5.11

Blood pressure parameters in KEEP & NHANES participants, by CKD stageKEEP = 44,673. NHANES N = 9,400.

5.12

Elevated blood pressure (JNC 7) in KEEP & NHANES participants, by CKD stageKEEP N = 44,673. NHANES N = 9,423.

Chapter 5 «» Chronic kidney disease s61

All non-CKD Stage 1 Stage 2 Stage 3 Stage 4-5

erusserp doolb detave le htiw

% 0

20

40

60

80

All non-CKD Stage 1 Stage 2 Stage 3 Stage 4-5

erusserp doolb tegrat gniteem

%

0

20

40

60

80

erusserp doolb detavele htiw tne creP

0

20

40

60

80

100CKDNo CKD

KEEP: Age Gender Race/ethnicity

0

20

40

60

80

100 NHANES 99-02

KEEP NHANES 99-02

All18-30

31-4546-60

61-7575+

MaleFemale

WhiteBlack

OtherHisp.

KEEP NHANES 99-02

All non-CKD Stage 1 Stage 2 Stage 3 Stage 4-5

erusserp doolb detave le htiw

% 0

20

40

60

80

All non-CKD Stage 1 Stage 2 Stage 3 Stage 4-5

erusserp doolb tegrat gniteem

%

0

20

40

60

80

erusserp doolb detavele htiw tne creP

0

20

40

60

80

100CKDNo CKD

KEEP: Age Gender Race/ethnicity

0

20

40

60

80

100 NHANES 99-02

KEEP NHANES 99-02

All18-30

31-4546-60

61-7575+

MaleFemale

WhiteBlack

OtherHisp.

KEEP NHANES 99-02

5.13

KEEP & NHANES participants meeting the target blood pressure (JNC 7), by CKD stageKEEP N = 44,673. NHANES N = 9,423.

5.14

Elevated blood pressure (JNC 7) in KEEP & NHANES participants with or without CKD, by age, gender, & race/ethnicityKEEP N = 44,673, age & gender; 43,770, race/ethnicity. NHANES N = 9,157.

mong KEEP participants with or without CKD,

35.6 and 41%, respec-tively, are prehyperten-

sive, while 36.9% of NHANES partici-pants have this condition. Nearly 70% of KEEP participants with CKD report being hypertensive compared to 47% of those without a CKD diagnosis. In NHANES participants with or without CKD, 37.3 and 23%, respectively, report hypertension.

In the KEEP populations, systolic blood pressure increases from 131.7 mmHg in

those with no CKD to 144.7 mmHg in those classified as having Stage 4–5 CKD. When compared to the NHANES popu-lation, more than twice as many KEEP participants have a measured elevated blood pressure.

Fewer than half of KEEP participants meet the target blood pressure level, and in KEEP participants with CKD, the percent with an elevated blood pressure increases with age, is higher in men than in women, and is highest in blacks com-pared to whites and individuals of other races.

National Kidney Foundation «» Kidney Early Evaluation Program «» 2006 s62

diabetes

s e t e b a i d d e t r o p e r - f l e s h t i w

t n e c r e P

0

10

20

30

40

50

CKD No CKD

KEEP: Age Gender Race/ethnicity

All 18-30 31-45 46-60 61-75 75+ 0

10

20

30

40

50

Male Female White Black Other Hispanic

NHANES 99-02

*

s e t e b a i d d e t r o p e r - f l e s h t i w

t n e c r e P

0

25

50

75 KEEP: CKD NHANES 99-02

Male Female 0

25

50

75

Male Female

No CKD All Underweight Normal

Overweight Obese Extremely Obese

* *

s e t e b a i d d e t r o p e r - f l e s h t i w

t n e c r e P

0

10

20

30

40

50

CKD No CKD

KEEP: Age Gender Race/ethnicity

All 18-30 31-45 46-60 61-75 75+ 0

10

20

30

40

50

Male Female White Black Other Hispanic

NHANES 99-02

*

s e t e b a i d d e t r o p e r - f l e s h t i w

t n e c r e P

0

25

50

75 KEEP: CKD NHANES 99-02

Male Female 0

25

50

75

Male Female

No CKD All Underweight Normal

Overweight Obese Extremely Obese

* *

5.15

Self-reported diabetes in KEEP & NHANES participants with or without CKD, by age, gender, & race/ethnicityKEEP N = 44,925 age & gender; 44,041, race/ethnicity. NHANES N = 9,714. *Sample size less than 30 or coefficient of variation not less than 30%.

5.16

Self-reported diabetes in KEEP & NHANES participants with or without CKD, by BMI category & genderKEEP N = 44,339. NHANES N = 9,714. *Sample size less than 30 or coefficient of variation not less than 30%.

Chapter 5 «» Chronic kidney disease s63

All NCKD Stage 1 Stage 2 Stage 3 Stage 4-5

setebaid detrope r-f les h tiw tnecreP

0

20

40

60 KEEP

All NCKD Stage 1 Stage 2 Stage 3 Stages 4-50

20

40

60 NHANES 99-02

5.17

Self-reported diabetes in KEEP & NHANES participants, by CKD stageKEEP N = 44,925. NHANES N = 11,432.

n both the KEEP and NHANES populations, self-reported dia-betes is most prominent in par-ticipants with CKD—at 36.1 and 15.7%, respectively—compared

to 22 and 4.8% of those without the di-agnosis.

By gender, diabetes is 12–17% more com-mon in male and female participants with CKD compared to those without the diagnosis. Thirty-four and 36% of white and black KEEP participants with CKD, respectively, report having diabetes com-pared to 23 and 21% of those without the diagnosis. The highest rates of diabetes occur in participants of other races and

Hispanics, at 42 and 39%, respectively.

Overall, the percent of KEEP participants with self-reported diabetes increases with BMI regardless of CKD status. Among participants with CKD, sixty-four per-cent of men are classified as extremely obese compared to 53.1% of women. In the non-CKD KEEP population, 34–35% are classified as extremely obese.

Nearly 52% of KEEP participants with Stage 4–5 CKD report having diabetes, compared to 22.4% in the NHANES population. Diabetes is evident in 42, 40, and 33%, of Stage 1, 2 and 3 participants, respectively.

National Kidney Foundation «» Kidney Early Evaluation Program «» 2006 s64

obesity

AllNCKD

Stage 1Stage 2

Stage 3Stage 4-5

All NCKD Stage 1 Stage 2 Stages 3-5

ytisebo htiw tnecreP

0

10

20

30

40

50 KEEP NHANES 99-02UWNOW

OBEOB

*

*

*

0

20

40

60 KEEP: Age

All 18-45 46-60 61+

Perc

ent w

ith B

MI ≥

30 k

g/m

2 )

0

20

40

60CKD NCKD

Male Female

Gender

NHANES 99-02

0

20

40

60

80

100Obesity

Normal

SRDM yesAll SRHTN yesSRDM no

CKD

KEEP NHANES KEEP NHANES KEEP NHANES KEEP NHANES KEEP NHANES

stna

picitrap fo t

necreP

0

20

40

60

80

100NCKD

SRHTN no

AllNCKD

Stage 1Stage 2

Stage 3Stage 4-5

All NCKD Stage 1 Stage 2 Stages 3-5

ytisebo htiw tnecreP

0

10

20

30

40

50 KEEP NHANES 99-02UWNOW

OBEOB

*

*

*

0

20

40

60 KEEP: Age

All 18-45 46-60 61+

Perc

ent w

ith B

MI ≥

30 k

g/m

2 )

0

20

40

60CKD NCKD

Male Female

Gender

NHANES 99-02

0

20

40

60

80

100Obesity

Normal

SRDM yesAll SRHTN yesSRDM no

CKD

KEEP NHANES KEEP NHANES KEEP NHANES KEEP NHANES KEEP NHANES

stna

picitrap fo t

necreP

0

20

40

60

80

100NCKD

SRHTN no

5.18

BMI in KEEP & NHANES participants, by CKD stageKEEP N = 44,711, NHANES N = 10,132. *Sample size less than 30 or coefficient of variation not less than 30%.

5.19

BMI ≥30 kg/m2 in KEEP & NHANES participants with or without CKD, by age KEEP N = 44,711. NHANES N = 9,459.

5.20

BMI in KEEP & NHANES participants with or without CKD, by self-reported diabetes or hypertensionKEEP N = 43,832. NHANES N = 9,459, all; 9,455, diabetes; 9,344 hypertension.

Chapter 5 «» Chronic kidney disease s65

Male Female0

20

40

60

80

ytisebo htiw t necreP

0

20

40

60

80 CKD

No CKD

All White Black Other Hispanic Non-Hisp.0

20

40

60

80

ytisebo htiw t necre P

0

20

40

60

80KEEP NHANES 99-02

CKD

No CKDAll Non-Hispanic All Hispanic Mexican

Puerto RicanCuban Other Hispanic

5.21

Obesity (BMI ≥ 30 kg/m2) in KEEP participants with or without CKD, by gender & Hispanic ethnicityKEEP N = 34,021, all. 5,427, Hispanic ethnicity.

5.22

Obesity (BMI ≥ 30 kg/m2) in KEEP & NHANES participants with or without CKD, by race/ethnicityKEEP N = 43,824, race; 44,711, ethnicity. NHANES N = 9,459.

n the KEEP and NHANES populations overall, 32.9 and 34.2%, respectively, are classified as overweight; 35.7 and 25.3% are classified as obese. The greatest

proportions of KEEP participants who are either overweight or obese occur in those who are classified as having Stage 1 or Stage 2 CKD.

Obesity is most prominent in KEEP and NHANES participants age 46–60, re-gardless of CKD status. Except for male NHANES participants with CKD, obe-sity is more prominent in females.

In KEEP participants with CKD, 56.4% of those who report having diabetes are classified as obese, while 43.6% are clas-sified as having a normal BMI; in those

with CKD who report having hyperten-sion, 35.4% are classified as obsese and 64.6% are classified as normal.

With the exception of male KEEP par-ticipants with Puerto Rican heritage and without a diagnosis of CKD, the propor-tions of participants who are classified as obese is generally distributed equally among all Hispanic ethnicities.

Black KEEP participants with or without a diagnosis of CKD are the most likely to have a BMI ≥30 kg/m2—56 and 52%, re-spectively—followed by whites at 41 and 40%, and individuals of other races at 42 and 39%. Non-Hispanics are slightly more likely to have a BMI equal to or exceeding 30 kg/m2 regardless of CKD status.

National Kidney Foundation «» Kidney Early Evaluation Program «» 2006 s66

smoking

All18-45

46-6061+

stnapicitrap fo t nec re P

0

20

40

60 KEEP CKD: Age Gender NHANES 99-02: Age Gender

All18-30

31-4546-60

61-7575+

0

20

40

60

MaleFemale

MaleFemale

No CKD

All

NCKD

Stage 1

Stage 2

All

NCKD

Stage 1

Stage 2

Stage 3

Stage 4

Stage 5

PB detavele ht iw tne creP

0

20

40

60

80

100Never smoked Used to smoke Smoking

Stages 3-5

KEEP NHANES:99-02

Never smoked Used to smoke Smoking

All18-45

46-6061+

stnapicitrap fo t nec re P

0

20

40

60 KEEP CKD: Age Gender NHANES 99-02: Age Gender

All18-30

31-4546-60

61-7575+

0

20

40

60

MaleFemale

MaleFemale

No CKD

All

NCKD

Stage 1

Stage 2

All

NCKD

Stage 1

Stage 2

Stage 3

Stage 4

Stage 5

PB detavele ht iw tne creP

0

20

40

60

80

100Never smoked Used to smoke Smoking

Stages 3-5

KEEP NHANES:99-02

Never smoked Used to smoke Smoking

5.23

Smoking status in KEEP & NHANES participants with or without CKD, by age & genderKEEP N = 42,571. NHANES N = 8,700; participants age 20 and older.

5.24

Elevated blood pressure (JNC 7) in KEEP & NHANES participants, by CKD stage & smoking statusKEEP N = 42,027. NHANES N = 8,406, all; 8,182, CKD; participants age 20 and older.

Chapter 5 «» Chronic kidney disease s67

0

20

40

60

80 NHANES 99-02 CKDKEEP CKD

All White Black Other HispanicAll White Black Other HispanicNon-Hisp. Non-Hisp.

stnapicitrap f o tnecreP

0

20

40

60

80 No CKD

Never smoked Used to smoke Smoking

5.25

Smoking status in KEEP & NHANES participants with or without CKD, by race/ethnicityKEEP N = 41,746. NHANES N = 8,700, participants age 20 and older.

mong KEEP participants, a far greater proportion of

those without a CKD diagnosis report never

having smoked compared to those with the diagnosis. The proportion of KEEP participants who report never having smoked decreases with age in indivudu-als with no CKD, and, in contrast, in-creases with age in those with CKD. In the NHANES population, 47.7% of those with CKD report never smoking, compared to 50.5% without CKD. In both the KEEP and NHANES popula-tions, more females than males report not smoking regardless of CKD status.

The percentage of KEEP participants with elevated blood pressure varies little through Stage 4 of CKD and is highest in those with Stage 5 CKD. Ironically, participants who used to smoke or have never smoked are more likely to have an elevated blood pressure.

By race/ethnicity, in both the KEEP and NHANES populations, little variation is noted by smoking category, regardless of CKD status.

National Kidney Foundation «» Kidney Early Evaluation Program «» 2006 s68

ckd risk factors

KEEP NHANES 99-02

0:3.24

1: 14.72: 32.8

4: 14.3

5: 2.5

3: 32.4

0: 8.1

1: 20.8

2: 37.5

4: 6.05: 0.5

3: 27.1

Self-reported DM No self-reported DM

PB deta vele htiw s tnap icitra p fo

% 0

20

40

60

80

100

Self-reported DM No self-reported DM

KEEP NHANES 99-02

Never smoked Used to smoke Smoking

PB detavele ht iw s tna pici trap fo

% 0

20

40

60

80

100 KEEP NHANES 99-02

Never smoked Used to smoke Smoking

All <25

25-29.930+

All <25 25-29.9 30+

KEEP NHANES 99-02

0:3.24

1: 14.72: 32.8

4: 14.3

5: 2.5

3: 32.4

0: 8.1

1: 20.8

2: 37.5

4: 6.05: 0.5

3: 27.1

Self-reported DM No self-reported DM

PB deta vele htiw s tnap icitra p fo

% 0

20

40

60

80

100

Self-reported DM No self-reported DM

KEEP NHANES 99-02

Never smoked Used to smoke Smoking

PB detavele ht iw s tna pici trap fo

% 0

20

40

60

80

100 KEEP NHANES 99-02

Never smoked Used to smoke Smoking

All <25

25-29.930+

All <25 25-29.9 30+

KEEP NHANES 99-02

0:3.24

1: 14.72: 32.8

4: 14.3

5: 2.5

3: 32.4

0: 8.1

1: 20.8

2: 37.5

4: 6.05: 0.5

3: 27.1

Self-reported DM No self-reported DM

PB deta vele htiw s tnap icitra p fo

% 0

20

40

60

80

100

Self-reported DM No self-reported DM

KEEP NHANES 99-02

Never smoked Used to smoke Smoking

PB detavele ht iw s tna pici trap fo

% 0

20

40

60

80

100 KEEP NHANES 99-02

Never smoked Used to smoke Smoking

All <25

25-29.930+

All <25 25-29.9 30+

5.26

Percent distribution of KEEP & NHANES participants with CKD, by number of risk factors for CKDKEEP N = 12,994. NHANES N = 1,129, participants age 20 and older.

5.27

Elevated blood pressure (JNC 7) in KEEP & NHANES participants with CKD, by BMI category & self-reported diabetic statusKEEP N = 12,689. NHANES N = 1,265.

5.28

Elevated blood pressure (JNC 7) in KEEP & NHANES participants with CKD, by BMI & smoking statusKEEP N = 12,023. NHANES N = 1,208, all; 1,130, BMI, participants age 20 and older.

Chapter 5 «» Chronic kidney disease s69

No Anemia Anemia

PB detavele htiw s tnap icitrap fo

% 0

20

40

60

80

100

No Anemia Anemia

KEEP NHANES 99-02srotcaf k sir ht i

w s tna pici trap fo tnecr eP

0

10

20

30

40

50

All No CKD Stage 1 Stage 2 Stages 3-50

10

20

30

40

50

KEEP

NHANES 99-02

**

* * *

All <25

25-29.930+

NoneOneTwo

ThreeFourFive

No Anemia Anemia

PB detavele htiw s tnap icitrap fo

% 0

20

40

60

80

100

No Anemia Anemia

KEEP NHANES 99-02

srotcaf k sir ht iw s tna pici trap fo tnecr eP

0

10

20

30

40

50

All No CKD Stage 1 Stage 2 Stages 3-50

10

20

30

40

50

KEEP

NHANES 99-02

**

* * *

All <25

25-29.930+

NoneOneTwo

ThreeFourFive

5.29

Elevated blood pressure (JNC 7) in KEEP & NHANES participants with CKD, by BMI category & anemia (WHO definition) statusKEEP N = 12,620. NHANES N = 1,264, all; 1,186, BMI.

5.30

Number of risk factors for cardiovascular disease in KEEP & NHANES participants, by CKD stageKEEP N = 45,311. NHANES N = 8,044, all; 7,989, CKD, participants age 20 and older. *Sample size less than 30 or coefficient of variation not less than 30%.

n the KEEP and NHANES pop-ulations 32.8 and 37.5%, respec-tively have two risk factors, while 32.4 and 27.1%, respectively have

three risk factors.

KEEP and NHANES participants with a BMI ≥30 kg/m2 are generally the most likely to have an elevated blood pressure, regardless of diabetic status or smoking status.

Anemia does not appear to influence the likelhood of having an elevated blood pressure in KEEP participants; in the NHANES population, elevated blood pressure is most evident in participants with no anemia and a BMI of ≥30 kg/m2.

The percent of KEEP participants with two risk factors increases as the severity of CKD increases, ranging from 28–34%.

National Kidney Foundation «» Kidney Early Evaluation Program «» 2006 s70

microalbuminuria & albumin/creatinine ratio

All Normal

Abnormal Hyperfilters

All Normal

Abnormal Hyperfilters

All Normal

Abnormal Hyperfilters

n i m

u b l a o r c i

m

e v i t i s o p h t i w

%

0

20

40

60 KEEP

0

10

20

30

40

R C

A l a

m

r o n b a h t i w

%

0

5

10

15

20 KEEP NHANES 99-02

KEEP

All 1 2 3 4-5

n i m

u b l a o r c i

m

e v i t i s o p h t i w

%

0

20

40

60

80

100 KEEP

All 1 2 3 4-5

Mea

n m

icro

albu

min

(mg/

L)

0

20

40

60

80

100

All 1 2 3 4-5

R C

A l a

m

r o n b a h t i w

%

0

25

50

75

100 KEEP NHANES 99-02

KEEP

eGFR stages

eGFR stages

All 1 2 3 4-5

n i m

u b l a o r c i

m

e v i t i s o p h t i w

%

0

25

50

75

100 KEEP

All 1 2 3 4-5 0

50

100

150

All 1 2 3 4-5

R C

A l a

m

r o n b a h t i w

%

0

20

40

60

80

100 KEEP

All 1 2 3 4-5

R C

A l a

m

r o n b a h t i w

%

0

20

40

60

80

100 KEEP NHANES 99-02 *

* Non-diabetics Diabetics

Mea

n m

icro

albu

min

(mg/

L)

Mea

n m

icro

albu

min

(mg/

L)

All Normal

Abnormal Hyperfilters

All Normal

Abnormal Hyperfilters

All Normal

Abnormal Hyperfilters

n i m

u b l a o r c i

m

e v i t i s o p h t i w

%

0

20

40

60 KEEP

0

10

20

30

40

R C

A l a

m

r o n b a h t i w

%

0

5

10

15

20 KEEP NHANES 99-02

KEEP

All 1 2 3 4-5

n i m

u b l a o r c i

m

e v i t i s o p h t i w

%

0

20

40

60

80

100 KEEP

All 1 2 3 4-5

Mea

n m

icro

albu

min

(mg/

L)

0

20

40

60

80

100

All 1 2 3 4-5 R

C

A l a m

r o n b a h t i

w

%

0

25

50

75

100 KEEP NHANES 99-02

KEEP

eGFR stages

eGFR stages

All 1 2 3 4-5

n i m

u b l a o r c i

m

e v i t i s o p h t i w

%

0

25

50

75

100 KEEP

All 1 2 3 4-5 0

50

100

150

All 1 2 3 4-5

R C

A l a

m

r o n b a h t i w

%

0

20

40

60

80

100 KEEP

All 1 2 3 4-5

R C

A l a

m

r o n b a h t i w

%

0

20

40

60

80

100 KEEP NHANES 99-02 *

* Non-diabetics Diabetics

Mea

n m

icro

albu

min

(mg/

L)

Mea

n m

icro

albu

min

(mg/

L)

All Normal

Abnormal Hyperfilters

All Normal

Abnormal Hyperfilters

All Normal

Abnormal Hyperfilters

n i m

u b l a o r c i

m

e v i t i s o p h t i w

%

0

20

40

60 KEEP

0

10

20

30

40

R C

A l a

m

r o n b a h t i w

%

0

5

10

15

20 KEEP NHANES 99-02

KEEP

All 1 2 3 4-5

n i m

u b l a o r c i

m

e v i t i s o p h t i w

%

0

20

40

60

80

100 KEEP

All 1 2 3 4-5

Mea

n m

icro

albu

min

(mg/

L)

0

20

40

60

80

100

All 1 2 3 4-5

R C

A l a

m

r o n b a h t i w

%

0

25

50

75

100 KEEP NHANES 99-02

KEEP

eGFR stages

eGFR stages

All 1 2 3 4-5

n i m

u b l a o r c i

m

e v i t i s o p h t i w

%

0

25

50

75

100 KEEP

All 1 2 3 4-5 0

50

100

150

All 1 2 3 4-5

R C

A l a

m

r o n b a h t i w

%

0

20

40

60

80

100 KEEP

All 1 2 3 4-5

R C

A l a

m

r o n b a h t i w

%

0

20

40

60

80

100 KEEP NHANES 99-02 *

* Non-diabetics Diabetics

Mea

n m

icro

albu

min

(mg/

L)

Mea

n m

icro

albu

min

(mg/

L)

5.31

Microalbuminuria & albumin/creatinine ratio in KEEP & NHANES participants, by creatinine clearance level (KEEP MDRD)KEEP N = 48,014. NHANES N = 10,254 all; 9,670, creatinine clearance level. Positive microalbumin, >20mg/L

5.32

Microalbumnuria & albumin/creatinine ratio in KEEP & NHANES participants, by eGFR stage (MDRD)KEEP N = 48,014, microalbuminuria; 43,657, ACR. NHANES N = 10,254, all; 9,670, eGFR. Positive microalbumin, >20mg/L

5.33

Microalbuminuria & albumin/creatinine ratio in KEEP & NHANES participants, by eGFR stage & diabetic statusKEEP N = 47,602, microalbuminuria; 43,296, ACR. NHANES N = 10,249, all; 9,666, eGFR. *Sample size less than 30 or coefficient of variation not less than 30%. Positive microalbumin, >20mg/L

Chapter 5 «» Chronic kidney disease s71

eGFR stages

eGFR stages

All 1 2 3 4-5

n i m

u b l a o r c i

m

e v i t i s o p h t i w

%

0

20

40

60

80

100 KEEP

All 1 2 3 4-5

Mea

n m

icro

albu

min

(mg/

L)

0

50

100

150

All 1 2 3 4-5

R C

A l a

m

r o n b a h t i w

%

0

20

40

60

80

100 Elevated BP No elevated BP

KEEP

All 1 2 3 4-5

R C

A l a

m

r o n b a h t i w

%

0

20

40

60

80

100 *

All 1 2 3 4-5

n i m

u b l a o r c i

m

e v i t i s o p h t i w

%

0

20

40

60

80

100 KEEP

All 1 2 3 4-5 0

50

100

150 Smoking Used to smoke Never smoked

All 1 2 3 4-5

R C

A l a

m

r o n b a h t i w

%

0

20

40

60

80

100 Current smoker or used to smoke Never smoked

KEEP

KEEP NHANES 99-02

KEEP NHANES 99-02

All 1 2 3 4-5 R

C

A l a m

r o n b a h t i

w

%

0

20

40

60

80

100

*

*

Normal Pre-HTN Stage 1 Stage 2

Mea

n m

icro

albu

min

(mg/

L)eGFR stages

eGFR stages

All 1 2 3 4-5

n i m

u b l a o r c i

m

e v i t i s o p h t i w

%

0

20

40

60

80

100 KEEP

All 1 2 3 4-5

Mea

n m

icro

albu

min

(mg/

L)

0

50

100

150

All 1 2 3 4-5

R C

A l a

m

r o n b a h t i w

%

0

20

40

60

80

100 Elevated BP No elevated BP

KEEP

All 1 2 3 4-5

R C

A l a

m

r o n b a h t i w

%

0

20

40

60

80

100 *

All 1 2 3 4-5

n i m

u b l a o r c i

m

e v i t i s o p h t i w

%

0

20

40

60

80

100 KEEP

All 1 2 3 4-5 0

50

100

150 Smoking Used to smoke Never smoked

All 1 2 3 4-5

R C

A l a

m

r o n b a h t i w

%

0

20

40

60

80

100 Current smoker or used to smoke Never smoked

KEEP

KEEP NHANES 99-02

KEEP NHANES 99-02

All 1 2 3 4-5

R C

A l a

m

r o n b a h t i w

%

0

20

40

60

80

100

*

*

Normal Pre-HTN Stage 1 Stage 2

Mea

n m

icro

albu

min

(mg/

L)

5.34

Microalbuminuria & albumin/creatinine ratio in KEEP & NHANES participants, by eGFR stage & JNC 7 blood pressure stageKEEP N = 47,353, microalbuminuria; 43,046, ACR. NHANES N = 9,329, all; 9,121, eGFR. *Sample size less than 30 or coefficient of variation not less than 30%. Positive micro-albumin, >20mg/L

5.35

Microalbuminuria & albumin/creatinine ratio in KEEP & NHANES participants, by eGFR stage and smoking historyKEEP N = 41,008. NHANES N = 9,178, all; 8,652, eGFR; participants age 20 and older. *Sample size less than 30 or coefficient of variation not less than 30%. Positive microalbu-min, >20mg/L

positive urinary albumin ( >20mg/L) is most likely

in KEEP participants classified as “hyperfil-

trators,” while mean microalbumin lev-els are similar across creatinine clearance levels.

Nearly 30% more KEEP participants with Stage 4–5 eGFR have a positive urine mi-croalbumin test compared to those at an earlier eGFR stage. KEEP participants who report having diabetes are more prone to microalbuminuria, have higher microalbumin levels, and are more likely to have an abnormal ACR.

KEEP participants with advanced stages of hypertension are the most likely to have a positive urine test for microalbu-min regardless of eGFR stage, and abnor-mal albumin/creatinine ratios are more common in those with elevated blood pressures.

Approximately 12–15% more KEEP par-ticipants with Stage 4–and 5 eGFR who used to smoke or never smoked have a positive test for microalbumin, while proportions of KEEP participants with an abnormal ACR are similar within each stage of eGFR regardless of smok-ing status.

National Kidney Foundation «» Kidney Early Evaluation Program «» 2006 s72

parathyroid hormoneHTP la

mro nba htiw tnecreP

0

10

20

30

40

50 Age Gender Race/ethnicity

)L/lomp(

HTP naeM

0

20

40

60

80

100 Age Gender Race/ethnicity

NDM DM NHTN HTN NCVD CVD

HTP lamronba hti

w tnecreP

0

10

20

30

40

NDM DM NHTN HTN NCVD CVD

)L/lomp(

HTP naeM

0

20

40

60

80

All18-30

31-5555-60

61-7575+

MaleFemale

WhiteBlack

OtherHisp.

All18-30

31-5555-60

61-7575+

MaleFemale

WhiteBlack

OtherHisp.

HTP lamro nba hti

w tnecreP

0

10

20

30

40

50 Age Gender Race/ethnicity

)L/lomp(

HTP naeM

0

20

40

60

80

100 Age Gender Race/ethnicity

NDM DM NHTN HTN NCVD CVD

HTP lamronba hti

w tnecreP

0

10

20

30

40

NDM DM NHTN HTN NCVD CVD

)L/lomp(

HTP naeM

0

20

40

60

80

All18-30

31-5555-60

61-7575+

MaleFemale

WhiteBlack

OtherHisp.

All18-30

31-5555-60

61-7575+

MaleFemale

WhiteBlack

OtherHisp.

5.36

PTH in KEEP participants, by age, gender, & race/ethnicityKEEP N = 1,998, includes participants with eGFR 15–<60, intact PTH only.

5.37

Mean PTH in KEEP participants, by age, gender, & race/ethnicityKEEP N = 1,998, includes participants with eGFR 15–<60, intact PTH only.

5.38

PTH levels in KEEP participants, by self-reported diabetic & hypertensive status, & cardiovascular disease statusKEEP N = 1,998, eGFR 15–<60, intact PTH only.

5.39

Mean PTH in KEEP participants, by self-reported diabetic & hypertensive status, & cardiovascular disease statusKEEP N = 1,998, includes participants with eGFR 15–<60, intact PTH only.

wenty-eight percent of KEEP participants have an abnormal PTH. The percent of KEEP participants with an abnormal value increases with age, reaching 43% in those age 75 and older. Abnormal values are more

evident in males than in females, and are similar in whites and blacks, at 29.1 and 29.8%, respectively. Mean PTH levels also increase as age increases and are highest in male and black participants.

Approximately 36% of participants diagnosed with diabetes or cardiovascular disease have abnormal PTH levels. And mean PTH levels are more likely in participants who have a comorbid conditions compared to those with no comorbidity.

Seventy-four percent of KEEP participants with an eGFR of <30 ml/min/1.73 m2 have an abnormal PTH compared to 21.1% of those with an eGFR of 55–59. Mean PTH levels reach 155 pmol/L in these individuals, more than three times the level found in those with an eGFR of 55–59 ml/min/1.73m2.

Compared to participants with Stage 3 CKD, nearly three times as many KEEP participants with Stage 4 CKD have abnormal PTH levels. And mean PTH levels in participants with abnormal hemoglobins are 26 pmol/L higher than levels found in those with normal hemoglobins.

KEEP participants with a BMI ≥25 kg/m2 have a mean PTH level of 60 pmol/L, compared to 52.3 in those with a BMI under 25 kg/m2.

Chapter 5 «» Chronic kidney disease s73

eGFR(ml/min/1.73 m2) eGFR(ml/min/1.73 m2)

<30 30-39 40-49 50-54 55-59

HTP lamronba hti

w tn ecreP

0

20

40

60

80

<30 30-39 40-49 50-54 55-59

)L/lomp(

HTP naeM

0

50

100

150

200

Stage 3 Stage 4

HTP lamronba hti

w tnecr eP

0

20

40

60

80

Stage 3 Stage 4

)L/lomp(

HTP naeM

0

40

80

120

160

CKD stage WHO anemia definitionNormal Hgb Abnormal Hgb

HTP lamronba hti

w tnecreP

0

10

20

30

40

50

Normal Hgb Abnormal Hgb

)L/lomp(

HTP naeM

0

20

40

60

80

100

BMI<25 BMI 25+

HTP lamron ba hti

w tn ecreP

0

10

20

30

40

BMI<25 BMI 25+

)L/lomp(

HTP na eM

0

20

40

60

80

(BMI kg/m2)

eGFR(ml/min/1.73 m2) eGFR(ml/min/1.73 m2)

<30 30-39 40-49 50-54 55-59

HTP lamronba hti

w tn ecreP

0

20

40

60

80

<30 30-39 40-49 50-54 55-59

)L/lomp(

HTP naeM

0

50

100

150

200

Stage 3 Stage 4

HTP lamronba hti

w tnecr eP

0

20

40

60

80

Stage 3 Stage 4

)L/lomp(

HTP naeM

0

40

80

120

160

CKD stage WHO anemia definitionNormal Hgb Abnormal Hgb

HTP lamronba hti

w tnecreP

0

10

20

30

40

50

Normal Hgb Abnormal Hgb

)L/lomp(

HTP naeM

0

20

40

60

80

100

BMI<25 BMI 25+

HTP lamron ba hti

w tn ecreP

0

10

20

30

40

BMI<25 BMI 25+

)L/lomp(

HTP na eM

0

20

40

60

80

(BMI kg/m2)

eGFR(ml/min/1.73 m2) eGFR(ml/min/1.73 m2)

<30 30-39 40-49 50-54 55-59

HTP lamronba hti

w tn ecreP

0

20

40

60

80

<30 30-39 40-49 50-54 55-59

)L/lomp(

HTP naeM

0

50

100

150

200

Stage 3 Stage 4

HTP lamronba hti

w tnecr eP

0

20

40

60

80

Stage 3 Stage 4

)L/lomp(

HTP naeM

0

40

80

120

160

CKD stage WHO anemia definitionNormal Hgb Abnormal Hgb

HTP lamronba hti

w tnecreP0

10

20

30

40

50

Normal Hgb Abnormal Hgb

)L/lomp(

HTP naeM

0

20

40

60

80

100

BMI<25 BMI 25+

HTP lamron ba hti

w tn ecreP

0

10

20

30

40

BMI<25 BMI 25+

)L/lomp(

HTP na eM

0

20

40

60

80

(BMI kg/m2)

5.42

PTH in KEEP participants, by CKD stageKEEP N = 1,998, eGFR 15–<60, intact PTH only.

5.43

PTH levels in KEEP participants, by WHO anemia status KEEP N = 1,998, participants with eGFR 15–<60, intact PTH only.

5.44

PTH in KEEP participants, by BMIKEEP N = 1,998, eGFR 15–<60, intact PTH only.

5.41

Mean PTH level in KEEP participants, by eGFR KEEP N = 1,998, includes participants with eGFR 15–<60, intact PTH only.

5.40

PTH in KEEP participants, by eGFR KEEP N = 1,998, includes participants with eGFR 15–<60, intact PTH only.

National Kidney Foundation «» Kidney Early Evaluation Program «» 2006 s74

calcium m ui clac l a

mron ba htiw tne creP 0

2

4

6

8

10 Age Gender Race/ethnicity

)ld/gm(

muiclac naeM

8.0

8.5

9.0

9.5

10.0 Age Gender Race/ethnicity

NDM DM NHTN HTN NCVD CVD

muiclac lam ronba hti

w tnecre P 0

2

4

6

8

NDM DM NHTN HTN NCVD CVD

)ld/gm(

muiclac naeM

8.0

8.5

9.0

9.5

10.0

All18-30

31-5555-60

61-7575+

MaleFemale

WhiteBlack

OtherHisp.

All18-30

31-5555-60

61-7575+

MaleFemale

WhiteBlack

OtherHisp.

m ui clac l amron ba hti

w tne creP 0

2

4

6

8

10 Age Gender Race/ethnicity

)ld/gm(

muiclac naeM

8.0

8.5

9.0

9.5

10.0 Age Gender Race/ethnicity

NDM DM NHTN HTN NCVD CVD

muiclac lam ronba hti

w tnecre P 0

2

4

6

8

NDM DM NHTN HTN NCVD CVD

)ld/gm(

muiclac naeM

8.0

8.5

9.0

9.5

10.0

All18-30

31-5555-60

61-7575+

MaleFemale

WhiteBlack

OtherHisp.

All18-30

31-5555-60

61-7575+

MaleFemale

WhiteBlack

OtherHisp.

5.45

Calcium in KEEP participants, by age, gender, & race/ethnicityKEEP N = 459, includes participants with eGFR 15–<60 CLS only.

5.46

Mean calcium levels in KEEP participants, by age, gender, & race/ethnicityKEEP N = 459, includes participants with eGFR 15–<60 CLS only.

5.47

Calcium levels in KEEP participants, by self-reported diabetic & hypertensive status, & cardiovascular disease statusKEEP N = 459, includes participants with eGFR 15–<60 CLS only.

5.48

Mean calcium level in KEEP participants, by self-reported diabetic & hypertensive status, & cardiovascular disease statusKEEP N = 459, includes participants with eGFR 15–<60 CLS only.

hite and Hispanic KEEP participants are the most likely to have an abnormal

calcium level. Mean levels are generally similar in KEEP participants across all age,

gender, and race/ethnicity categories, rang-ing from a maximum of 9.4 mg/dl in participants age 18–30 to a minimum of 9.1 in those age 75 and older, 9.0–9.2 in males versus females, and 9.1–9.2 in all racial and ethnic categories.

Six percent of KEEP participants who have diabetes have an abnormal calcium level, compare to 5% in those with hypertension or cardiovascular disease; comorbidity, however, does not appear to impact calcium levels.

Slightly over 14% of KEEP participants with an eGFR of less than 30 ml/min/1.73 m2 have an abnor-mal calcium level, compared to 4.6% of those with a eGFR of 55–59.

Fourteen percent of KEEP participants classified as having Stage 4 CKD have an abnormal calcium level, compared to 4.5% of those with Stage 3 CKD. Mean calcium levels are similar in KEEP participants with normal or abnormal hemoglobins.

Seven percent of KEEP participants with a BMI un-der 25 kg/m2 have an abnormal calcium, compared to 4.9% of those whose BMI reaches 25 kg/m2 or greater.

Chapter 5 «» Chronic kidney disease s75

eGFR (ml/min/1.73 m2) eGFR (ml/min/1.73 m2)

<30 30-39 40-49 50-54 55-59

muiclac lamronba hti

w t necreP 0

5

10

15

<30 30-39 40-49 50-54 55-59

)ld/gm(

muiclac naeM

8.0

8.5

9.0

9.5

10.0

Stage 3 Stage 4

muiclac lamr onba hti

w tnecre P 0

5

10

15

Stage 3 Stage 4

)ld/gm(

muiclac naeM

8.0

8.5

9.0

9.5

10.0

CKD stage

Normal Hgb Abnormal Hgb

muiclac lamronba hti

w tne cre P 0

2

4

6

Normal Hgb Abnormal Hgb

)ld/gm(

muiclac naeM

8.0

8.5

9.0

9.5

10.0

WHO anemia definition

BMI<25 BMI 25+

muiclac lamro nba hti

w tnecr eP 0

2

4

6

8

BMI<25 BMI 25+

)ld/gm(

muicla c na eM

8.0

8.5

9.0

9.5

10.0

(BMI kg/m2)

eGFR (ml/min/1.73 m2) eGFR (ml/min/1.73 m2)

<30 30-39 40-49 50-54 55-59

muiclac lamronba hti

w t necreP 0

5

10

15

<30 30-39 40-49 50-54 55-59

)ld/gm(

muiclac naeM

8.0

8.5

9.0

9.5

10.0

Stage 3 Stage 4

muiclac lamr onba hti

w tnecre P 0

5

10

15

Stage 3 Stage 4

)ld/gm(

muiclac naeM

8.0

8.5

9.0

9.5

10.0

CKD stage

Normal Hgb Abnormal Hgb

muiclac lamronba hti

w tne cre P 0

2

4

6

Normal Hgb Abnormal Hgb

)ld/gm(

muiclac naeM

8.0

8.5

9.0

9.5

10.0

WHO anemia definition

BMI<25 BMI 25+

muiclac lamro nba hti

w tnecr eP 0

2

4

6

8

BMI<25 BMI 25+

)ld/gm(

muicla c na eM

8.0

8.5

9.0

9.5

10.0

(BMI kg/m2)

eGFR (ml/min/1.73 m2) eGFR (ml/min/1.73 m2)

<30 30-39 40-49 50-54 55-59

muiclac lamronba hti

w t necreP 0

5

10

15

<30 30-39 40-49 50-54 55-59

)ld/gm(

muiclac naeM

8.0

8.5

9.0

9.5

10.0

Stage 3 Stage 4

muiclac lamr onba hti

w tnecre P 0

5

10

15

Stage 3 Stage 4

)ld/gm(

muiclac naeM

8.0

8.5

9.0

9.5

10.0

CKD stage

Normal Hgb Abnormal Hgbmuiclac la

mronba htiw tne cre P 0

2

4

6

Normal Hgb Abnormal Hgb

)ld/gm(

muiclac naeM

8.0

8.5

9.0

9.5

10.0

WHO anemia definition

BMI<25 BMI 25+

muiclac lamro nba hti

w tnecr eP 0

2

4

6

8

BMI<25 BMI 25+

)ld/gm(

muicla c na eM

8.0

8.5

9.0

9.5

10.0

(BMI kg/m2)

5.51

Calcium levels in KEEP participants, by CKD stageKEEP N = 459, includes participants with eGFR 15–<60 CLS only.

5.52

Calcium in KEEP participants, by WHO anemiaKEEP N = 459, includes participants with eGFR 15–<60 CLS only.

5.53

Calcium in KEEP participants, by BMIKEEP N = 459, includes participants with eGFR 15–<60 CLS only.

5.50

Mean calcium level in KEEP participants, by eGFR KEEP N = 459, includes participants with eGFR 15–<60 CLS only.

5.49

Calcium in KEEP participants, by eGFR KEEP N = 459, includes participants with eGFR 15–<60 CLS only.

National Kidney Foundation «» Kidney Early Evaluation Program «» 2006 s76

phosphorus )l d/g

m( .s ohp lamronb a ht i

w tnecre P

0

1

2

3

4

5

6 Age Gender Race/ethnicity

)ld/gm( surohpsohp nae

M

0

1

2

3

4 Age Gender Race/ethnicity

NDM DM NHTN HTN NCVD CVD

surohpsohp lam ronba hti

w t ne creP 0.0

0.5

1.0

1.5

2.0

NDM DM NHTN HTN NCVD CVD

)ld/gm( surohpsohp nae

M

2.0

2.5

3.0

3.5

4.0

All18-30

31-5555-60

61-7575+

MaleFemale

WhiteBlack

OtherHisp.

All18-30

31-5555-60

61-7575+

MaleFemale

WhiteBlack

OtherHisp.

)l d/gm( .s ohp la

mronb a ht iw tnecre P

0

1

2

3

4

5

6 Age Gender Race/ethnicity

)ld/gm( surohpsohp nae

M

0

1

2

3

4 Age Gender Race/ethnicity

NDM DM NHTN HTN NCVD CVD

surohpsohp lam ronba hti

w t ne creP 0.0

0.5

1.0

1.5

2.0

NDM DM NHTN HTN NCVD CVD

)ld/gm( surohpsohp nae

M

2.0

2.5

3.0

3.5

4.0

All18-30

31-5555-60

61-7575+

MaleFemale

WhiteBlack

OtherHisp.

All18-30

31-5555-60

61-7575+

MaleFemale

WhiteBlack

OtherHisp.

5.54

Phosphorus in KEEP participants, by age, gender, & race/ethnicityKEEP N = 459, includes participants with eGFR 15–<60 CLS only.

5.55

Mean phosphorus level in KEEP participants, by age, gender, & race/ethnicityKEEP N = 459, includes participants with eGFR 15–<60 CLS only.

5.56

Phosphorus in KEEP participants, by self-reported diabetic & hypertensive status, & cardiovascular disease statusKEEP N = 459, includes participants with eGFR 15–<60 CLS only.

5.57

Mean phosphorus in KEEP participants, by self-reported diabetic & hypertensive status, & cardiovascular disease statusKEEP N = 459, includes participants with eGFR 15–<60 CLS only.

early 1% of KEEP participants have an abnormal phosphorus level. By age, levels are highest in participants age 55–60, at 2.6 mg/dl, in males at 1.9 versus 0.34 in females, and in Hispan-ics at 5.6 compared to 1.1 in whites.

Mean phosphorus levels in KEEP participants are similar across all age, gender, and race/ethnicity cat-egories, at 3.4 mg/dl overall.

Percentages of KEEP participants with an abnormal phosphorus level are similar regardless of comorbid-ity status, but are slightly higher in participants with hypertension. Mean phosphorus levels average 3.4 mg/dl in KEEP participants with or without comor-bid conditions.

Nearly 3% of KEEP participants with an eGFR less than 30 ml/min/1.73 m2 have an abnormal phos-phorus compared to 1% of those with an eGFR of 55–59.

Mean phosphorus levels are highest in KEEP partic-ipants with an eGFR less than 30 ml/min/1.73 m2.

The percent of KEEP participants with an abnormal phosphorus is highest in those classified as having Stage 4 CKD; approximately 2% of KEEP partici-pants with a normal hemoglobin have an abnormal phosphorous.

Mean phosphorus levels are slightly higher in KEEP participants with a BMI less than 25 kg/m2 com-pared to those with a BMI ≥25 kg/m2.

Chapter 5 «» Chronic kidney disease s77

<30 30-39 40-49 50-54 55-59

surohpsohp lamro nba hti

w tnecreP 0

1

2

3

<30 30-39 40-49 50-54 55-59

)ld/gm( surohpsohp nae

M

2.0

2.5

3.0

3.5

4.0

Stage 3 Stage 4

surohpsohp lamr onba ht i

w tne cre P 0

1

2

3

Stage 3 Stage 4

)ld/gm( surohposhp nae

M

2.0

2.5

3.0

3.5

4.0

CKD stage

Normal Hgb Abnormal Hgb

surohpsohp l amronba hti

w tne creP 0

1

2

3

Normal Hgb Abnormal Hgb

)ld/gm(surohpsohp nae

M

2.0

2.5

3.0

3.5

4.0

WHO anemia definition

BMI<25 BMI 25+

surohpsohp lamronb a h ti

w tne creP 0.0

0.5

1.0

1.5

2.0

BMI<25 BMI 25+

)ld/gm( su roh psohp na e

M

2.0

2.5

3.0

3.5

4.0

eGFR (ml/min/1.73 m2) eGFR (ml/min/1.73 m2)

(BMI kg/m2)

<30 30-39 40-49 50-54 55-59

surohpsohp lamro nba hti

w tnecreP 0

1

2

3

<30 30-39 40-49 50-54 55-59

)ld/gm( surohpsohp nae

M

2.0

2.5

3.0

3.5

4.0

Stage 3 Stage 4

surohpsohp lamr onba ht i

w tne cre P 0

1

2

3

Stage 3 Stage 4

)ld/gm( surohposhp nae

M

2.0

2.5

3.0

3.5

4.0

CKD stage

Normal Hgb Abnormal Hgb

surohpsohp l amronba hti

w tne creP 0

1

2

3

Normal Hgb Abnormal Hgb

)ld/gm(surohpsohp nae

M

2.0

2.5

3.0

3.5

4.0

WHO anemia definition

BMI<25 BMI 25+

surohpsohp lamronb a h ti

w tne creP 0.0

0.5

1.0

1.5

2.0

BMI<25 BMI 25+

)ld/gm( su roh psohp na e

M

2.0

2.5

3.0

3.5

4.0

eGFR (ml/min/1.73 m2) eGFR (ml/min/1.73 m2)

(BMI kg/m2)

<30 30-39 40-49 50-54 55-59

surohpsohp lamro nba hti

w tnecreP 0

1

2

3

<30 30-39 40-49 50-54 55-59

)ld/gm( surohpsohp nae

M

2.0

2.5

3.0

3.5

4.0

Stage 3 Stage 4

surohpsohp lamr onba ht i

w tne cre P 0

1

2

3

Stage 3 Stage 4

)ld/gm( surohposhp nae

M

2.0

2.5

3.0

3.5

4.0

CKD stage

Normal Hgb Abnormal Hgbsurohpsohp l a

mronba htiw tne creP 0

1

2

3

Normal Hgb Abnormal Hgb

)ld/gm(surohpsohp nae

M

2.0

2.5

3.0

3.5

4.0

WHO anemia definition

BMI<25 BMI 25+

surohpsohp lamronb a h ti

w tne creP 0.0

0.5

1.0

1.5

2.0

BMI<25 BMI 25+

)ld/gm( su roh psohp na e

M

2.0

2.5

3.0

3.5

4.0

eGFR (ml/min/1.73 m2) eGFR (ml/min/1.73 m2)

(BMI kg/m2)

5.60

Phosphorus levels in KEEP participants, by CKD stageKEEP N = 459, includes participants with eGFR 15–<60 CLS only.

5.61

Phosphorus levels in KEEP participants, by WHO anemiaKEEP N = 459, includes participants with eGFR 15–<60 CLS only.

5.62

Phosphorus levels in KEEP participants, by BMIKEEP N = 459, includes participants with eGFR 15–<60 CLS only.

5.59

Mean phosphorus in KEEP participants, by eGFR KEEP N = 459, includes participants with eGFR 15–<60 CLS only.

5.58

Phosphorus levels in KEEP participants, by eGFR KEEP N = 459, includes participants with eGFR 15–<60 CLS only.

National Kidney Foundation «» Kidney Early Evaluation Program «» 2006 s78

chapter highlights

Figure 5.3Using the new CKD definition, 29% percent have CKD compared to 57% under the old definition.

Figure 5.12 When compared to the NHANES population, more than twice as many KEEP participants have a measured elevated blood pressure.

Figure 5.15In both the KEEP and NHANES populations, self-reported diabetes is most prominent in participants with CKD—at 36.1 and 15.7%, respectively—compared to 22 and 4.8% of those without the diagnosis.

Figure 5.18In the KEEP and NHANES populations overall, 32.9 and 34.2%, respectively, are classified as overweight; 35.7 and 25.3% are classified as obese.

Figure 5.26 In the KEEP and NHANES populations the percentage of participants with 2–3 risk factors ranges from 27.1 to 37.5%.

Figure 5.32Nearly 30% more KEEP participants with Stage 4–5 eGFR have a positive urine microalbumin test compared to those at an earlier eGFR stage.

Figure 5.36Twenty-eight percent of KEEP participants have an abnormal PTH. The percent of KEEP participants with an abnormal value increases with age, reaching 43% in those age 75 and older.

Figure 5.45White and Hispanic KEEP participants are the most likely to have an abnormal calcium level.

DiabetesSelf-reported diabetes Elevated blood sugar

JNC 7 HyperteNsioNNormalsystolic <120 mmHg & diastolic <80 mmHg

prehypertensionsystolic 120-139 mmHg or diastolic 80-89

mmHg

stage 1systolic 140-159 mmHg or diastolic 90-99

mmHg

stage 2systolic ≥160 mmHg or diastolic ≥100 mmHg

elevateD blooD pressure (ebp) (JNC 7)DM or CKD:systolic: ≥130 mmHg or diastolic: ≥80 mmHg

No DM or CKD:systolic: ≥140 mmHg or

diastolic: ≥90 mm Hg

MeaN blooD pressure(Systolic-Diastolic)/3 + Diastolic

CKD DefiNitioNIf eGFR by K/DOQI MDRD <60 ml/min/1.73

m2 or eGFR ≥60 ml/min/1.73 m2 and abnormal albumin/creatinine ratio (ACR ≥30mg/g)

CKD stagesStage 1: eGFR ≥90, ACR ≥30 mg/gStage 2: eGFR 60–89, ACR ≥30 mg/gStage 3: eGFR 30–59Stage 4: eGFR 15–29Stage 5: eGFR <15 or dialysis

boDy Mass iNDex CategoriesUW: underweight, BMI <18.5N: normal, BMI 18.5–24.9OW: overweight, BMI 25–29.9OB: obese, BMI 30–39.9EOB: extremely obese, BMI ≥40

risK faCtors for CarDiovasCular DiseaseDiabetesBMI ≥30 kg/m2

Smoking historyAnemia (WHO definition)Elevated blood pressure

WHo aNeMia DefiNitioNMale: hemoglobin <13 g/dlFemale: <12 g/dl

CreatiNiNe ClearaNCe level (Keep MDrD)Normal: male, 100–125, female 90–110Abnormal: male, <100, female, <90Hyperfiltration: male, >125, females, >110

abNorMal albuMiN/CreatiNiNe ratio (aCr)

ACR ≥30 mg/g

positive MiCroalbuMiN>20 mg/L

egfr stagesStage 1: eGFR ≥90 Stage 2: eGFR 60–89Stage 3: eGFR 30–59Stage 4: eGFR 15–29Stage 5: eGFR <15

ptH NorMal levelsK/DoQiStage 3 CKD: 35–70Stage 4 CKD: 75–110(PTH test administered after May 1, 2005,

for participants with eGFR <60 ml/min/1.73 m2.)

CalCiuM NorMal levels8.4–10.2 mg/dl(Calcium test administered after May 1, 2005,

for participants with eGFR <60 ml/min/1.73 m2.)

pHospHorus NorMal levels2.3–4.7 mg/dl(Phosphorus test administered after May 1,

2005, for participants with eGFR <60 ml/min/1.73 m2.)