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PubMed2005

Preventing chronic kidney disease in special populations.

Hypertension is a major risk factor for chronic kidney disease (CKD), cardiovascular disease, cerebrovascular events, and premature death. However, certain groups are known to be at higher risk for hypertensive end-organ damage, including diabetic patients, older patients with isolated systolic hypertension, and specific ethnic populations. Coexistent diabetes and hypertension dramatically increase the risk of developing CKD and other target-organ complications. The prevalence of hypertension, left ventricular hypertrophy, CKD, hypertensive renal disease, and end-stage renal disease (ESRD) is far greater in African Americans compared with white Americans. Identification of patients at increased risk for CKD offers the potential to prevent or delay ESRD and the cardiovascular events associated with CKD. Data from completed and ongoing controlled clinical hypertension trials will assist clinicians in creating optimal antihypertensive regimens for patients at increased risk for CKD.

Black or African American↗
PubMed2005

Epidemiology and risk factors for chronic kidney disease.

Kidney disease is highly prevalent in the United States population and groups at high risk for increased prevalence of CKD include individuals with a family history of ESRD, diabetes, hypertension, and cardiovascular disease. Despite the increased risk of ESRD observed for blacks compared with whites, racial disparities in the prevalence of kidney disease have not been consistently demonstrated in the United States population. Although the reasons for discrepancy in risk of ESRD and CKD have not been established, clinicians should be aware that more rapid progression of CKD among blacks is a possible explanation for this observation and that closer monitoring and intensive care of risk factors associated with progressive renal injury is warranted for blacks with CKD and in other high-risk groups. Therapeutic interventions that delay or prevent progressive kidney disease are well established and incorporated into widely disseminated clinical practice guidelines. These interventions include aggressive blood pressure control with agents that block the renin-angiotensin system, reduction of dietary protein to recommended levels for the American diet, weight loss, smoking cessation, and control of hyperlipidemia. These interventions also reduce the risk of cardiovascular disease and should be regarded as essential components of care of CKD. Achieving high levels of medically appropriate care of CKD patients and reduction in risk of progression to ESRD may be delayed by barriers created by individual and regional poverty.

Humans↗
PubMed2003

Cardiovascular complications in chronic kidney disease.

The risk for cardiovascular disease (CVD) morbidity and mortality remains alarmingly high in all stages of chronic kidney disease (CKD). CVD often begins before end-stage renal disease (ESRD), and patients with reduced kidney function are more likely to die of CVD than to develop ESRD. Three pathological forms of CVD should be considered in patients with CKD: alterations in cardiac geometry, including left ventricular hypertrophy, atherosclerosis, and arteriosclerosis. All are highly prevalent in patients with CKD. Although patients with CKD share many of the same risk factors for CVD as the general population, there are a number of uremia-related risk factors, such as anemia and alterations in calcium/phosphorus metabolism, that also play a role in promoting CVD. Treatment of both traditional and uremia-related risk factors should be initiated in the earlier stages of CKD. Additional clinical trials with a goal to reduce CVD are urgently needed in CKD.

Adult↗
PubMed2004

[The interest of statins in nephrology].

STATINS IN THE CASE OF CHRONIC RENAL DISEASE: Data of several large clinical trials in the general population demonstrated that hydroxymethyl glutaryl coenzyme A reductase inhibitors (statins) are effective in cardiovascular disease prevention with a relatively safe profile. Patients with chronic kidney disease (CKD) are at high risk for developing premature cardiovascular disease, so the benefits of statin therapy might be expected to be substantial in this population. Adjusted dose of statins to calcinurine inhibitors and renal function seem to exhibit a favorable risk/benefit ratio in CKD patients. STUDY RESULTS: Statin use is CKD patients has been associated with a certain efficacy of cardiovascular disease prevention in several uncontrolled trials, and one randomized trial in renal transplant recipients. Several other large-scale randomized trials in CKD patients [4D (atorvastatin), AURORA (rosuvastatin) and SHARP (simvastatin/ezetimib) are currently underway. The results of these trials will permit evidence-based medicinal arguments justifying life-long clinical use of statins for cardiovascular prevention in CKD patients with progressive renal dysfunction, but data are inconclusive. OTHER POSSIBLE EFFECTS: Clinically relevant plethoric effects associated with statin therapy in CKD patients might be restricted to the decrease of inflammation and oxidative stress.

Chronic Disease↗
PubMed2004

Impact of chronic kidney disease upon survival among implantable cardioverter-defibrillator recipients.

BACKGROUND: Chronic kidney disease (CKD) has been linked to serious arrhythmias. We studied the impact of CKD upon implantable cardioverter-defibrillator (ICD) recipients. METHODS AND RESULTS: Baseline estimated glomerular filtration rate (eGFR) was calculated from variables at the time of ICD implantation in 95 patients. Patients with eGFR below 60 ml/min and those with end-stage renal disease (ESRD) were considered to have significant CKD. Among 95 patients who underwent ICD implantation for VT/VF, the mean age was 66.5+/-12.2 years, 27 (29.0%) were women and 20 (21.5%) were African American. The CKD groups (eGFR < 60 ml/min and ESRD) and control group (eGFR > or = 60 ml/min) were similar with respect to background histories and medications. A significant difference in all-cause mortality in those with eGFR >or = 60 ml/min, 3 patients (8.6%), compared to either those with eGFR < 60 ml/min, 28 (60.9%), or ESRD 7 patients (58.3%), p < 0.0001, was noted. Proportionately more patients died from arrhythmic deaths in those with eGFR < 60 ml/min, 8 patients (17.39%) and ESRD 3 patients (25%), than those with eGFR > or = 60 ml/min, no patient. P < or = 0.0001. There was progressive increase in DFT's with worsening renal failure. The Cox proportional hazards model for time until death, found independent predictors to be: age, OR = 1.04 (per year), 95% CI 1.00-1.08, p = 0.04; CKD group, OR 2.59, 95% CI 1.27-5.30, p = 0.009; and use of beta-blockers, OR 0.25, 95% CI 0.10-0.61, p = 0.002. CONCLUSIONS: Significant CKD was related to overall poor survival, arrhythmic death and high DFTs.

Aged↗
PubMed2006

Elevated resistin levels in chronic kidney disease are associated with decreased glomerular filtration rate and inflammation, but not with insulin resistance.

In the present study, we explore the role of decreased renal function and a genetic polymorphism on the recently discovered protein resistin, apparently able to inhibit hepatic insulin action in mice. We also investigate possible links with inflammation and the insulin resistance present in patients with chronic kidney disease (CKD). This is a post hoc, cross-sectional study comparing 239 prevalent CKD patients with varying degrees of renal function impairment with an age- and gender-matched randomly selected control group of 25 individuals. Glomerular filtration rate (GFR) was estimated by the mean of urea and creatinine clearance (24-h urine samples) (n=204) or by iohexol clearance (n=60). Plasma analysis of blood lipids, insulin, glucose, inflammatory markers (high-sensitivity C-reactive protein, interleukin-6, tumor necrosis factor-alpha, vascular cellular adhesion molecule, intercellular adhesion molecule) and resistin (kit from LINCO Research, St Charles, MS) was performed using commercially available assays or routine methods. Insulin resistance was estimated by quantitative insulin-sensitivity check index (QUICKI) and homeostasis model assessment for insulin resistance (HOMA-IR) and body composition by dual-energy X-ray absorptiometry. Genotyping of a C/G promoter single nucleotide polymorphism (n=168) at position -180 of the resistin gene was performed by PyroSequencing. Serum levels of resistin were markedly elevated in the CKD patients with both advanced (39.9+/-1.3 ng/ml) and mild to moderate (23.2+/-1.0 ng/ml) renal function impairment, as compared to controls (8.5+/-0.7 ng/ml; P<0.001). In a multiple linear regression model in patients (adjusted r(2)=0.60), only GFR (beta=3.4; P<0.0001), lean body mass (beta=2.2; P<0.001) and the inflammatory markers were independently associated with circulating resistin levels. There was a weak but significant impact of -180 C/G genotype on plasma levels of resistin (median 43.0+/-2.4 ng/ml in CC, 37.5+/-2.0 ng/ml in CG, and 41.1+/-4.9 ng/ml in GG; P<0.05). Univariate analysis of non-diabetic patients and controls showed that serum resistin was associated with markers of glucose metabolism. However, in a multiple regression model, resistin, as well as all the measured markers of inflammation, was only associated with insulin resistance if GFR was not taken into account. Circulating resistin levels are strongly associated with both GFR and inflammatory biomarkers in CKD. As the significant relationship between plasma resistin levels and insulin resistance was lost following the correction for GFR, resistin is not a likely mediator of insulin resistance in patients with CKD. Renal function is an important factor to take into account in clinical studies relating insulin sensitivity to inflammatory biomarkers in CKD as well as in patients with diabetes mellitus, who often have an impaired renal function.

Adult↗
PubMed2006

Definition, evaluation, and classification of renal osteodystrophy: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO).

Disturbances in mineral and bone metabolism are prevalent in chronic kidney disease (CKD) and are an important cause of morbidity, decreased quality of life, and extraskeletal calcification that have been associated with increased cardiovascular mortality. These disturbances have traditionally been termed renal osteodystrophy and classified based on bone biopsy. Kidney Disease: Improving Global Outcomes (KDIGO) sponsored a Controversies Conference on Renal Osteodystrophy to (1) develop a clear, clinically relevant, and internationally acceptable definition and classification system, (2) develop a consensus for bone biopsy evaluation and classification, and (3) evaluate laboratory and imaging markers for the clinical assessment of patients with CKD. It is recommended that (1) the term renal osteodystrophy be used exclusively to define alterations in bone morphology associated with CKD, which can be further assessed by histomorphometry, and the results reported based on a unified classification system that includes parameters of turnover, mineralization, and volume, and (2) the term CKD-Mineral and Bone Disorder (CKD-MBD) be used to describe a broader clinical syndrome that develops as a systemic disorder of mineral and bone metabolism due to CKD, which is manifested by abnormalities in bone and mineral metabolism and/or extra-skeletal calcification. The international adoption of these recommendations will greatly enhance communication, facilitate clinical decision-making, and promote the evolution of evidence-based clinical practice guidelines worldwide.

Chronic Kidney Disease-Mineral and Bone Disorder↗
PubMed2006

Beta blockers in the management of chronic kidney disease.

The sympathetic nervous system modulates renal function through its receptors namely beta1 (cardiac output and renin release), alpha1 (systemic and renovascular constriction), and beta2 renovascular dilation. Sympathetic overactivity is commonly seen in chronic kidney disease (CKD) and is an important contributor to increasing the risk of cardiovascular events as well as increasing renal disease progression. Recent evaluations of drug use in people with CKD shows a remarkably low percentage of patients receiving beta-blockers, especially in more advanced stage CKD when cardiovascular risk is higher. This is in large part due to tolerability of these agents. Moreover, water-soluble beta-blockers such as atenolol and metoprolol are dialyzable and require supplementation to avoid exacerbation of arrhythmias following dialysis. Newer vasodilating beta-blockers have better tolerability and different effects on renal hemodynamics as well as metabolic variables. These effects are related to the relative alpha1-blocking effect of agents such as carvedilol and labetolol, with carvedilol having relatively greater alpha-blocking effects. Few studies evaluate beta-blockers on cardiovascular risk in CKD patients. Studies with carvedilol demonstrate attenuated increases in albuminuria as well as reduction in cardiovascular events in CKD patients with hypertension. This paper reviews the animal and clinical trial data that evaluate beta-blockers in CKD highlighting the vasodilating beta-blockers. It is apparent that greater use of this drug class for blood pressure control would further enhance reduction of risk of heart failure, the most common cause of death in the first year of starting dialysis.

Adrenergic beta-Antagonists↗
PubMed2003

Blood lead and chronic kidney disease in the general United States population: results from NHANES III.

BACKGROUND: High lead exposure is associated with hypertension and renal dysfunction but the effect of low-level environmental exposure is not as well studied. METHODS: We examined the association between blood lead and renal function among a representative sample of the civilian noninstitutionalized United States population with and without hypertension, age 20 years old or older, participating in the Third National Health and Nutrition Examination Survey (NHANES III) (N=15211). Elevated serum creatinine was defined as >or=99th percentile of each race-sex specific distribution for healthy young adults and chronic kidney disease (CKD) as a glomerular filtration rate (GFR) <60 mL/min estimated using the Modification of Diet in Renal Disease (MDRD) formula. RESULTS: Among persons with and without hypertension, mean blood lead was 4.21 and 3.30 ug/dL, respectively, the prevalence of elevated serum creatinine was 11.5% and 1.8%, respectively, and CKD was 10.0% and 1.1%, respectively. Among persons with hypertension, a graded association was present between higher quartile of blood lead and a higher odds ratio of both an elevated serum creatinine and CKD. Comparing the highest to lowest quartile of blood lead, the multivariate adjusted odds ratio (95% CI) of an elevated serum creatinine and CKD were 2.41 (1.46, 3.97) and 2.60 (1.52, 4.45), respectively. The analogous adjusted odds ratios (95% CI) among normotensives were 1.09 (0.53, 2.22) and 1.09 (0.41, 2.89), respectively. Associations were consistent when modeling lead as a continuous variable and in all subgroups except smokers. CONCLUSION: In the United States population with hypertension, exposure to lead, even at low levels, is associated with CKD. Reduction of lead exposure may reduce the burden of CKD in the community.

Adult↗
PubMed2003

Study of Heart and Renal Protection (SHARP).

Among patients with preexisting coronary heart disease, large-scale randomized trials have demonstrated that lowering low-density lipoprotein (LDL)-cholesterol concentration by about 1 mmol/L for 4-5 years reduces the risk of coronary events and strokes by about 25%. Patients with established chronic kidney disease (CKD) are at high risk of vascular disease, so the benefits of cholesterol-lowering therapy might be expected to be substantial in this population. Patients with CKD have generally been excluded from previous trials, however, and there is currently no reliable randomized evidence that lowering LDL-cholesterol would be beneficial among them. There are several reasons why the demonstrated benefits of lowering blood cholesterol in other populations might not translate to patients with CKD. First, observational studies among dialysis patients have reported a negative association between blood total cholesterol and mortality. Second, only about one quarter of cardiac mortality in such patients appears to be attributable to acute myocardial infarction, and potentially avoidable with cholesterol lowering, while the other common causes (e.g., cardiac arrest, arrhythmia, and heart failure) may not be as dependent on cholesterol levels. Finally, the long-term safety of cholesterol reduction among patients with CKD remains unclear. Hence, there is an important need for reliable direct evidence on whether lowering cholesterol prevents a worthwhile proportion of vascular events, without unacceptable toxicity, among patients with CKD. The Study of Heart and Renal Protection (SHARP) aims to assess the effects of cholesterol-lowering therapy with a combination of simvastatin and the cholesterol-absorption inhibitor ezetimide among around 9000 patients with CKD.

Cholesterol, LDL↗
PubMedDate not supplied

The longitudinal chronic kidney disease study: a prospective cohort study of predialysis renal failure.

Chronic kidney disease (CKD) is a significant public health problem: every year the number of Americans living with CKD and requiring renal replacement therapy increases. In addition, individuals with CKD have substantially increased morbidity and mortality compared to the general population. The Longitudinal Chronic Kidney Dialysis (LCKD) Study is a multicenter, prospective, observational study of patients with moderate to severe CKD that was designed to better describe the course of the disease and the determinants of patient outcomes. Patients with moderate to severe CKD (glomerular filtration rate [GFR] < 60 ml/min/m2) from four academic nephrology clinics were enrolled between 2000 and 2002. Special cardiac and vascular testing has recently commenced as phase II of this study. Areas that have been or are currently being studied include anemia management, health-related quality of life (HRQOL), medication use, and markers of cardiovascular disease. This article describes the LCKD Study in the context of current knowledge of CKD.

Anemia↗
PubMed2003

Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey.

BACKGROUND: Recently developed clinical practice guidelines and calibration of the Third National Health and Nutrition Examination Survey (NHANES III) serum creatinine assay provide a basis for estimating the prevalence and distribution of chronic kidney disease (CKD) in the United States using standardized criteria based on estimated glomerular filtration rate (GFR) and persistent albuminuria. METHODS: A nationally representative sample of 15,625 noninstitutionalized adults aged 20 years and older from the NHANES III was analyzed. Kidney function (GFR), kidney damage (albuminuria), and stages of CKD (GFR and albuminuria) were estimated from calibrated serum creatinine level, spot urine albumin level, age, sex, and race. GFR was estimated using the simplified Modification of Diet in Renal Disease Study equation and compared with the Cockcroft-Gault equation for creatinine clearance (CCr). RESULTS: The prevalence of CKD in the US adult population was 11% (19.2 million). By stage, an estimated 5.9 million individuals (3.3%) had stage 1 (persistent albuminuria with a normal GFR), 5.3 million (3.0%) had stage 2 (persistent albuminuria with a GFR of 60 to 89 mL/min/1.73 m(2)), 7.6 million (4.3%) had stage 3 (GFR, 30 to 59 mL/min/1.73 m(2)), 400,000 individuals (0.2%) had stage 4 (GFR, 15 to 29 mL/min/1.73 m(2)), and 300,000 individuals (0.2%) had stage 5, or kidney failure. Aside from hypertension and diabetes, age is a key predictor of CKD, and 11% of individuals older than 65 years without hypertension or diabetes had stage 3 or worse CKD. Compared with GFR estimates, CCr estimates showed a steeper decline with age and were lower in non-Hispanic blacks. CONCLUSION: CKD is common and warrants improved detection and classification using standardized criteria to improve outcomes. Am J Kidney Dis 41:1-12.

Adult↗
PubMed2005

Puberty and chronic kidney disease.

Puberty is a period of dramatic physiologic changes when children become adults. Chronic kidney disease (CKD), like many disorders, may delay or blunt the onset and outcomes of puberty. These include attainment of adult height and reproductive capacity. Although nutrition and treatment effects may contribute to these phenomena, increasing evidence supports direct biological effects of CKD on the neurohypophyseal axis that controls these systems. Although CKD affects puberty, this life period also impacts the progression of CKD. Diabetes mellitus, posterior urethral valves, reflux nephropathy, and hypoplasia all appear to accelerate with sexual maturation. Potential mechanisms include increases in blood pressure and body size as well as altered endocrine physiology. Better understanding of the interactions of puberty and CKD may lead to better outcomes for children with CKD as well as longer preservation of native kidney function.

Adolescent↗
PubMed2006

Bariatric surgery for morbid obesity: risks and benefits in chronic kidney disease patients.

Obesity is one of the most preventable causes of morbidity and mortality of the 21st century. Chronic kidney disease (CKD) has been a largely overlooked consequence of obesity; however, accumulating evidence elucidates the association. Obesity is at the core, promoting a cascade of secondary pathologies including diabetes, dyslipidemia, inflammation, hypertension, and the metabolic syndrome; these comorbidities constitute great risk for CKD. With the diagnosis of CKD, there is an increased threat of cardiovascular disease and the attendant increase in morbidity and mortality rates. Substantial weight loss in the obese population can be effectively achieved and maintained through bariatric surgery, which confers major health benefits by producing resolution or improvement of obesity-related comorbidities. This surgical procedure presents an early hazard of acute on chronic kidney failure, which is offset by a potential improvement in the risk of CKD progression with anticipated improvement in hypertension, diabetes, and CKD risk factors. Future research is needed to describe the clinical course and risks and benefits of bariatric surgery in the CKD population.

Albuminuria↗
PubMed2004

The effect of long-term aggressive lipid lowering on ischemic and atherosclerotic burden in patients with chronic kidney disease.

BACKGROUND: Cardiac mortality is the main cause of death in patients with chronic kidney disease (CKD). In this study, we sought the efficacy of long-term intensive lipid level lowering on atherosclerotic burden in patients with CKD. METHODS: Patients with CKD (n = 38; age, 64 +/- 11 years) and a similar group of patients with coronary artery disease (CAD; n = 31) were treated prospectively with atorvastatin, up to 80 mg/d. Lipid profile, carotid intima-media thickness (IMT; a marker of atherosclerotic burden), and dobutamine echocardiography were measured at baseline and 2 years. Predictors of change in maximal IMT were sought in a linear model. RESULTS: Despite similar cholesterol level lowering, patients with CAD showed an improvement in maximum IMT, whereas those with CKD did not (mean between-group difference, 0.07 mm; 95% confidence interval, 0.01 to 0.12). Change in maximal IMT was associated with kidney disease (R2 = 0.09; P = 0.013), smoking (R2 = 0.083; P = 0.017), baseline low-density lipoprotein cholesterol (LDL-C) level (R2 = 0.064; P = 0.045), very low density cholesterol (VLDL-C) level (R2 = 0.084; P = 0.021), and calcium channel blocker use (R2 = 0.094; P = 0.01). In a multivariate model, kidney disease and baseline LDL-C and VLDL-C levels remained independent predictors of change in maximal IMT (model R2 = 0.24; P = 0.004). Only patients with CAD decreased their number of ischemic segments (2.5 +/- 1.4 to 1.2 +/- 1.5 segments; P = 0.002). Overall change in ischemic segment number correlated with change in maximal IMT (r = 0.32; P = 0.019). CONCLUSION: Patients with CKD undergoing intensive lipid level lowering do not show the same changes in atherosclerotic or ischemic burden as patients with CAD. Independent predictors of change in maximal IMT were CKD and baseline LDL-C and VLDL-C levels.

Aged↗
PubMed2004

Unreferred chronic kidney disease: a longitudinal study.

BACKGROUND: Chronic kidney disease (CKD) is a major health problem. A better understanding of the epidemiological characteristics of the different stages of CKD and the associated adverse outcomes is needed to establish and implement appropriate management strategies. METHODS: A serum creatinine (SCr) level of 2.03 mg/dL or greater (> or =180 micromol/L) in men and 1.53 mg/dL or greater (> or =135 micromol/L) in women was used to identify patients with moderate to severe CKD in a predominantly Caucasian area of the United Kingdom. Patients who were unknown to renal services were identified and followed up to establish survival, rate of referral, and change in glomerular filtration rate (GFR). RESULTS: The prevalence of CKD defined by SCr cutoff values was 5,554 per million population (pmp). Median calculated GFR of the cohort was 28.5 mL/min/1.73 m2 (range, 4.1 to 42.8 mL/min/1.73 m2), and median age was 83 years (range, 18 to 103 years). A total of 84.8% of patients were unknown to renal services. During a mean follow-up of 31.3 months, 8.1% of patients were referred. Median survival of the unreferred population was 28.1 months. Cardiovascular disease, cancer, and infection were the most common causes of death. Male sex, low GFR, and nonreferral were associated with poor outcome. The majority of unreferred patients had stable renal function. The incidence of new unreferred CKD during the first year of follow-up was 2,435 pmp, such that the prevalence remained stable at 4,910 pmp. Significant anemia (hemoglobin < 11 g/dL [<110 g/L]) was seen in 27.5% of the unreferred cohort. CONCLUSION: Referral of all patients with CKD is unrealistic and inappropriate. Management strategies aimed at improving adverse outcomes need to take account of this and be developed and implemented through collaboration between primary care and secondary care.

Adult↗
PubMed2004

Clinical significance of cardiac troponin T levels in chronic kidney disease patients: predictive value for cardiovascular risk.

BACKGROUND: Recent studies have shown that cardiac troponin T (cTnT) levels predict cardiovascular mortality in hemodialysis patients. The aim of this study is to analyze the prognostic value of cTnT levels in stable patients with moderate chronic kidney disease (CKD). METHODS: One hundred seventy-six outpatients were included; 128 patients had an estimated glomerular filtration rate (GFR) less than 60 mL/min (<1 mL/s; CKD group), and 48 patients, 60 mL/min or greater (> or =1 mL/s; control group). Medical records for cardiovascular factors were recorded. Analytical parameters and cardiac markers were analyzed. Patients were followed up prospectively, and the end points were fatal and nonfatal cardiovascular events. RESULTS: cTnT levels were undetectable in all control group patients (cTnT < 0.01 ng/mL), and only 20 patients in the CKD group had detectable values (>0.01 ng/mL). Patients with detectable cTnT levels were older (P = 0.005), had a greater prevalence of congestive heart failure (CHF; P = 0.000) and left ventricular hypertrophy (P = 0.001), more anemia (P = 0.008), and a lower GFR (P = 0.008) than the rest of the patients in the CKD group. After a mean follow-up of 12.9 months, 20 patients in the CKD group and 1 patient in the control group experienced a cardiovascular event. Age (odds ratio [OR], 1.11), previous coronary artery disease (OR, 2.49), CHF (OR, 7.36), hemoglobin level (OR, 0.70), GFR (OR, 0.94), pulse pressure (OR, 1.02), and cTnT level (OR, 12.34) predicted cardiovascular events on univariate Cox analysis. CONCLUSION: In patients with CKD, cTnT level is a predictor of cardiovascular events.

Aged↗
PubMed2004

Awareness of kidney disease in the US population: findings from the National Health and Nutrition Examination Survey (NHANES) 1999 to 2000.

BACKGROUND: The prevalence of end-stage renal disease (ESRD) in the US population has been predicted to increase by 48% during the next decade and will pose a significant health cost burden. Early identification and treatment of chronic kidney disease (CKD) is necessary to delay progression from CKD to ESRD. CKD awareness among patients is crucial to early intervention programs, but its prevalence and characteristics in the noninstitutionalized US population are unknown. METHODS: The National Health and Nutrition Examination Survey 1999 to 2000 was used to determine prevalence estimates of kidney disease awareness, as well as demographics, health care access, and comorbid characteristics, of participants with CKD. RESULTS: In participants with CKD, 40.5% of patients with stage 1, 29.3% of patients with stage 2, 22.0% of patients with stage 3, and 44.5% of patients with stage 4 CKD were aware of their kidney disease, respectively. The aware and unaware groups did not differ by health care access. In multivariate regression modeling, lack of awareness was significantly associated with sex, race-ethnicity distribution, and hypertension. CONCLUSION: Kidney disease awareness is low among a representative sample of the noninstitutionalized US population. Groups at greater risk for kidney disease, such as non-Hispanic blacks, patients with hypertension, and men, were more likely to be unaware of having kidney disease, even with health care access similar to that of the aware group. Increased efforts to promote kidney disease awareness are needed and probably should target primary care providers involved in the screening process.

Adult↗