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PubMed2006

Proinflammatory effects of iron sucrose in chronic kidney disease.

Inflammation is a central component of progressive chronic kidney disease (CKD). Iron promotes oxidative stress and inflammatory response in animals and promotes progressive CKD. Parenteral iron provokes oxidative stress in patients with CKD; however, its potential to provoke an inflammatory response is unknown. In 20 veterans with CKD, 100 mg iron sucrose was administered intravenously over 5 min and urinary excretion rate and plasma concentration of monocyte chemoattractant protein-1 (MCP-1) were measured at timed intervals over 24 h. Patients were then randomized to placebo or N-acetyl cysteine (NAC) 600 mg b.i.d. and the experiment was repeated at 1 week. Iron sucrose markedly increased plasma concentration and urinary excretion rate of MCP-1 at baseline and at 1 week visits (P < 0.0001 for time effect). Urinary excretion peaked at 30 min and plasma concentration at 15 min. Plasma MCP-1 concentration fell from 164 +/- 17.7 to 135 +/- 17.7 pg/ml with NAC, whereas it remained unchanged from 133 +/- 12.5 to 132 +/- 17.7 pg/ml with placebo (P=0.001 for visit x antioxidant drug interaction). There was a reduction in MCP-1 urinary excretion rate from visit 1 to 2. At the baseline visit, the urinary excretion rate averaged 305 +/- 66 pg/min and at the second visit 245 +/- 67 pg/min (mean difference 60 +/- 28 pg/min, P = 0.030). There was no improvement in urinary MCP-1 excretion with NAC. In conclusion, iron sucrose causes rapid and transient generation and/or release of MCP-1 plasma concentration and increases urinary excretion rate, and systemic MCP-1 level but the urinary excretion rate is not abrogated with the antioxidant NAC. These results may have implications for the progression of CKD with parenteral iron.

Aged↗
PubMed2006

Cardiac troponins and chronic kidney disease.

The prevalence of coronary artery disease in patients with chronic kidney disease (CKD) is high, and acute myocardial infarction contributes significantly to the steep mortality rate in this population. Diagnosing an acute coronary syndrome in these patients is often difficult though essential. Traditional diagnostic tools such as symptoms and electrocardiographic manifestations are not entirely helpful in patients with CKD, and physicians are often left to rely on laboratory analysis of biomarkers such as cardiac troponin. However, troponin levels are increased in patients with renal failure in the absence of clinical myocardial ischemia, making their interpretation problematic. Several theories have been proposed for the mechanism of elevated troponin levels in CKD. Irrespective of our uncertainty regarding mechanism, studies have shown that there is a strong prognostic implication of elevated troponin levels; and that it is predictive of increased risk of mortality and cardiovascular events. Troponin levels rise over 6-8 h in the setting of acute myocardial injury; hence, it is imperative to obtain these levels sequentially in patients with CKD in whom a clinical cardiac event is suspected. A distinct rise and fall in the levels over baseline strongly support the diagnosis of acute myocardial necrosis. Despite uncertainties regarding increased troponins in patients with CKD, their value remains clear.

Biomarkers↗
PubMed2006

Prognostic importance of ambulatory blood pressure recordings in patients with chronic kidney disease.

Ambulatory systolic blood pressure (BP) correlates better with risk factors for progression of chronic kidney disease (CKD) compared to clinic measured BP, but its role in predicting end-stage renal disease (ESRD) and death in patients with CKD is unknown. In a cohort study of 217 Veterans with CKD BP was measured by ambulatory monitoring and in the clinic. Twenty-four hour ambulatory BP was 133.5 +/- 16.6/73.1 +/- 11.1 mm Hg and clinic BP was 155.2 +/- 25.6/84.7 +/- 14.2 mm Hg. The composite renal end point of ESRD or death over a median follow-up of 3.5 years occurred in 75 patients (34.5%), death occurred in 52 patients (24.0%), and ESRD in 36/178 patients (20.2%). Thirty-nine patients died before reaching ESRD. One standard deviation (s.d.) increase in systolic BP increased the risk of composite outcome to 1.69 (95% confidence interval (CI) 1.32-2.17) for standard clinic measurement and to 1.88 (95% CI 1.48-2.39) for 24 h ambulatory BP recording. One s.d. increase in 24 h ambulatory systolic BP increased the risk of ESRD to 3.04 (95% CI 2.13-4.35) and to 2.20 (95% CI 1.43-3.39) when adjusted for standard clinic systolic BP. Non-dipping was associated with increased risk of total mortality and composite end point. In patients with CKD, BPs obtained by ambulatory monitoring are a stronger predictor of ESRD or death compared to BPs obtained in the clinic. Systolic ambulatory BP and nondipping are independent predictors for ESRD after adjusting for clinic BP. However, adjustment for other risk factors for CKD progression removes the independent prognostic value of ambulatory BP.

Adult↗
PubMed2006

Reduced expression of Toll-like receptor 4 contributes to impaired cytokine response of monocytes in uremic patients.

Toll-like receptors (TLRs) play a pivotal role in pathogen recognition and subsequent cytokine synthesis by immune cells. Uremic patients have a high infectious morbidity, but it remains unclear if this arises from the defective innate immune responses related to TLRs. We studied TLR4 expression in monocytes and their intracellular cytokine synthesis in response to lipopolysaccharide (LPS) stimulation in 35 predialysis patients with chronic kidney disease (CKD) with or without predisposition to bacterial infections and 16 age-matched controls. Expression of TLR4 in unstimulated peripheral monocytes was determined by staining with anti-TLR4 antibody and analysis with flow cytometry. Monocytes were then stimulated by LPS, labeled with anti-CD14 antibody, and subjected to intracellular cytokine staining and flow cytometry. Tumor necrosis factor (TNF)-alpha, interleukin (IL)-1beta, IL-6, and IL-8 synthesis was examined in CD14(+) monocytes. TLR4 expression was constitutively diminished in CKD patients with reduced expression being more severe in those CKD patients who were predisposed to infections. Monocytes from these infection prone CKD patients exhibited significantly reduced synthesis of TNF-alpha, IL-1beta, IL-6, and IL-8 in response to LPS challenge compared with those from control subjects. The intensity of synthesis of each cytokine significantly correlated with TLR4 expression levels in monocytes (P<0.01). The capacity of monocytes to synthesize proinflammatory cytokines was significantly reduced in infection prone CKD patients, and this may possibly be due to the reduced monocyte expression of TLR4. Abnormal TLR4 expression by monocytes may play a role in the susceptibility of such patients to bacterial infections.

Aged↗
PubMed2003

Renal insufficiency and anemia are independent risk factors for death among patients with acute myocardial infarction.

BACKGROUND: Chronic kidney disease (CKD) increases risk of death among patients with coronary artery disease. Mortality risks associated with CKD among patients with cardiovascular disease (CVD) are not well defined. Anemia is associated with increased mortality in end-stage renal disease (ESRD) patients and may also increase risk among patients with CVD. METHODS: A random sample of patients admitted to the hospital in a single southern state with a principal diagnosis of acute myocardial infarction (ICD-9 codes 410.xx) were followed up after hospital discharge. RESULTS: CKD was found in 60% of the cohort. Hematocrit of >or=40 was found in 46% of the patients; 26.0% had a hematocrit between 36% and 39%, 21.8% between 30% and 35%, and 5.9% had a hematocrit of less than 30%. The 1-year death rates among individuals with and without CKD were 31.7% and 10.4% respectively [odds ratio (OR) = 4.00 (2.34, 6.91)]. The mortality at one year was 18.6% for individuals with a hematocrit greater than or equal to 40%; 23.5% (OR = 1.35; 95% CI = 0.78, 2.32) for hematocrit 36% to 39%; 30.7% (OR = 1.94; 95% CI = 1.12, 3.34) for hematocrit between 30% and 35%; and 35.8% (OR = 3.16; 95% CI = 1.35, 7.40) for those with a hematocrit less than 30% (chi2 for trend was 12.2, P = 0.007). Both hematocrit and serum creatinine were independently associated with increased risk of death during follow-up after controlling for other patient risk factors. CONCLUSION: CKD and decreasing hematocrit were frequent among older patients hospitalized for acute myocardial infarction and are independent predictors of subsequent risk of death.

Aged↗
PubMed2003

The nephrologist's role in the management of calcium-phosphorus metabolism in patients with chronic kidney disease.

BACKGROUND: In patients with chronic kidney disease (CKD), timely referral to a nephrologist has been shown to improve outcomes, but the specific care measures mediating these superior outcomes have not been sufficiently described. METHODS: In a cohort of 3014 patients with CKD, we evaluated whether they had any indicators of calcium-phosphorus metabolism management prior to renal replacement therapy (RRT). These included measurement of parathyroid hormone (PTH) or vitamin D metabolites, or receipt of calcitriol or calcium-containing phosphate binders (CCPB) prior to RRT. Control patients without such care were selected by risk-set matching. We used multivariate conditional logistic regression analysis to test whether use of these interventions was associated with prior nephrologist consultation. We then used Cox proportional hazards models to assess whether implementation of such care was associated with differences in 1-year mortality once RRT was instituted. RESULTS: Only 3.4% of CKD patients had their PTH assessed prior to RRT, and 0.3% had vitamin D status measured. Use of calcitriol (12.2%) and CCPBs (16%) was slightly more prevalent. Seeing a nephrologist was highly associated with use of the tests and drugs studied (odds ratio, 1.28 to 6.46; all P values <0.001), but care by generalists or other specialists was not. Management of calcium-phosphorus metabolism was independently associated with a 35% decreased likelihood of death (hazards ratio=0.65; 95%CI, 0.51 to 0.84) in the first year of RRT. CONCLUSION: Improvements in management of calcium-phosphorus metabolism in patients with CKD are attributable to nephrologist care and appear to mediate the survival benefit seen in patients who see a nephrologist relatively early in the course of their CKD.

Aged↗
PubMed2002

Role of combination therapy with ACE inhibitors and calcium channel blockers in renal protection.

Over recent years, a target blood pressure of 125/75 mm Hg has been sought in order to reduce the rate of chronic renal disease (CKD) progression and cardiovascular mortality. Some antihypertensive agents, such as angiotensin converting enzyme (ACE) inhibitors, angiotensin II receptor antagonists and calcium channel blockers also may be capable of reducing CKD progression because they halt some of the pathogenetic mechanisms involved in renal damage. The possibility that combination treatments with ACE inhibitors and calcium-channel blockers may confer additive or even synergistic renoprotective effects other than blood pressure control is not only fascinating, but also particularly important because multidrug antihypertensive regimens are required to obtain adequate blood pressure in the majority of patients with CKD. This combination may provide better blood pressure control, appears to be better tolerated with fewer side effects than either drug alone, and may exert a greater renoprotective effect in patients at risk for renal failure than either an ACE inhibitors or a calcium channel blocker. However, the current available data are too few to confirm this hypothesis. Cardiovascular disease accounts for more than 50% of the deaths of hemodialysis patients. Thus, care must be taken to prevent and treat the cardiovascular risk factors optimally from the early phase of CKD, and for this reason effective antihypertensive therapy is the most important treatment, not only in order to delay CKD progression, but also to reduce the burden of cardiovascular disease. In this perspective combination therapy with ACE inhibitors and calcium channel blockers can give further advantages.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2002

Family members of patients treated for ESRD have high rates of undetected kidney disease.

BACKGROUND: Early intervention during the course of chronic kidney disease (CKD) may delay the progression to end-stage renal disease (ESRD). Several studies have reported that relatives of patients with ESRD are at risk for kidney disease (KD), but little is known about the prevalence and awareness of CKD in this population, which is the object of this report. METHODS: We conducted a cross-sectional survey by way of a voluntary screening of relatives of patients with ESRD in 10 communities in one southeastern state. Age; race; sex; family and personal history of KD, hypertension, and diabetes; height; weight; and blood pressure were determined. Proteinuria and random blood glucose and serum creatinine were measured. Creatinine clearance (CrCl) was assessed using the Cockroft-Gault formula. RESULTS: Among 769 screened adults, 29.2% with a family history of ESRD were included in the study sample. CKD (CrCl < 90 mL/min) was present in 49.3%, 13.9% had a CrCl less than 60 mL/min, and 9.9% had proteinuria of 1+ or greater. Among those with a CrCl less than 60 mL/min or a proteinuria of 1+ or greater, or both, only 13.0% were aware of their KD. Awareness of CKD was not associated with age, race, sex, education, control of diabetes and hypertension, or physician's visits. Among those who had seen a physician recently, only 7.9% were aware of their KD. CONCLUSION: Awareness of KD is less than expected among relatives of patients with ESRD considering the high prevalence of CKD in this population. Screening these individuals might help identify people with early KD.

Adolescent↗
PubMed2006

Chronic kidney disease in solid-organ transplantation.

As the long-term survival of nonrenal solid-organ transplant recipients continues to improve, more complications related to transplantation occur. Among the most serious is chronic kidney disease (CKD). Although CKD was previously thought to only clinically affect a minority of this population, closer measurements of kidney function and monitoring of CKD complications now show that CKD will affect a significant number, if not a majority, of transplant recipients-particularly the long-term survivors who often have excellent function of their primary allograft. This article will review the incidence, risk factors, treatment, and outcomes of patients who develop CKD after heart, liver, and lung transplantation.

Follow-Up Studies↗
PubMed2006

Dietary recommendations for obese patients with chronic kidney disease.

For optimal management of chronic kidney disease (CKD), dietary modification should be an integral part of patient care. Dietary considerations for obese patients with CKD are numerous and complicated and involve modification of intake of calories, protein, fat, phosphorus, and electrolytes. General principles for dietary management of obese patients include (1) ensuring adequate monitoring of nutritional status through assessment of diet, nutrition-related laboratory parameters, and anthropometrics; (2) creation of an individualized diet plan that meets clinical guidelines and has favorable effects on obesity-related conditions such as blood pressure and lipids; (3) careful attention to patients' food choices, portion size, and food-preparation methods; (4) recommending adjustment of overall energy intake to promote weight loss, yet maintain good nutritional status; and (5) modification of diet as the patient's nutritional status changes and CKD progresses. The basic objectives of dietary modification are to lighten the excretory load of products of metabolism and to help the kidney maintain normal equilibrium of the body's internal environment. Dietary modifications must be individualized and appropriate to the stage of CKD. This review describes dietary factors important in optimizing nutritional status of obese patients with CKD. Additionally, current clinical practice guidelines and strategies for meeting them are discussed.

Calcium, Dietary↗
PubMed2004

Physical and sexual function in women with chronic kidney disease.

BACKGROUND: Cross-sectional studies suggest an association between functional status and chronic kidney disease (CKD). Whether physical function deteriorates with progression of CKD is unknown. METHODS: To determine associations among CKD, physical function, and sexual function in women, we conducted cross-sectional and longitudinal analyses of 2,761 women enrolled in the Heart and Estrogen/Progestin Replacement Study. Physical and sexual function were evaluated using the Duke Activity Status Index (DASI) and the Sexual Problems Scale of the Medical Outcomes Study, respectively. Glomerular filtration rate (GFR) was estimated using the Modification of Diet in Renal Disease regression equation. In addition to analyses across the spectrum of GFR, CKD was categorized as mild (estimated GFR, 45 to 60 mL/min/1.73 m2), moderate (estimated GFR, 30 to 44 mL/min/1.73 m2), and severe (estimated GFR, <30 mL/min/1.73 m2) according to a modification of recently established classification guidelines. RESULTS: Mean age of study participants was 67 +/- 7 years, and mean estimated GFR was 61 +/- 14 mL/min/1.73 m2. In unadjusted analyses, mean baseline DASI score was 10 points lower in women with an estimated GFR less than 30 mL/min/1.73 m2 than in women with an estimated GFR of 60 mL/min/1.73 m2 or greater (P < 0.0001). Estimated GFR remained significantly associated with DASI score after multivariable adjustment. In longitudinal analyses, a decline in estimated GFR was associated with a significant decline in DASI score independent of baseline estimated GFR and other factors. There were no significant associations between estimated GFR and psychosocial aspects of sexual function. CONCLUSION: CKD is associated with impaired physical function, and a decline in estimated GFR is associated with a decline in physical function.

Activities of Daily Living↗
PubMed2004

Evaluation of eHealth web sites for patients with chronic kidney disease.

BACKGROUND: Chronic kidney disease (CKD) affects up to 19.2 million Americans, and untreated kidney disease can progress to kidney failure. Patient education is an important part of slowing disease progression, but the ability of health professionals to provide this education is limited by time constraints. To date, there have been no systematic evaluations of CKD eHealth Web sites. METHODS: Seven nonproprietary and 4 proprietary Web sites geared toward educating patients with CKD were identified by using the Internet to search for the terms "chronic kidney disease," "kidney disease," and "chronic renal failure." Web sites were evaluated according to (1) compliance with the principles of the Health on the Net (HON) Foundation Code of Conduct and (2) reading grade level. RESULTS: Nonproprietary sites were in compliance with an average of 5.2 principles, with a range of 3 to 8. Average compliance of proprietary Web sites with the HON Code of Conduct principles was 3.12, with a range of 2 to 4 (P = 0.021). Of nonproprietary Web sites, average reading grade level assessed by the Fry Readability Scale was greater than grade 14, with a range from grade 11 through graduate school. Of proprietary sites, average readability was grade 11, with a range from grades 7 through 16 (P = 0.575). CONCLUSION: The Internet has the potential to be a very powerful educational tool for patients with CKD. However, many easily accessed CKD public health Web sites do not comply with accepted standards for health Web sites and are written using language beyond the general public's reading comprehension.

Adult↗
PubMed2005

Insulin resistance in patients with chronic kidney disease.

BACKGROUND: It has been reported that insulin resistance appears at an earlier stage of chronic kidney disease (CKD). However, few data are available concerning what factors of metabolic abnormalities, such as apolipoprotein (Apo) profile or acidosis, might be associated with insulin resistance in patients with CKD. METHODS: We used the hyperinsulinemic euglycemic glucose clamp technique to examine insulin sensitivity in patients without diabetes (n = 29) with different stages of renal function. Results were compared with those in healthy subjects (n = 10) and related to various affecting variables. RESULTS: In healthy subjects, the glucose disposal rate (GDR) was 9.93 +/- 1.33 mg/kg/min. The GDR of patients with CKD (6.91 +/- 2.46 mg/kg/min) was significantly less than that of healthy subjects ( P < 0.01), which shows diminished insulin sensitivity in patients with CKD. There was a negative correlation between GDR and serum creatinine level ( r = -0.449; P < 0.05) and positive correlations between GDR and creatinine clearance ( r = 0.549; P < 0.01) and Apo A-1/B levels ( r = 0.396; P < 0.05). Of particular relevance is the observed close correlation between GDR and bicarbonate level, with an extremely high predictive value for degree of acidosis ( r = 0.611; P < 0.0005). Stepwise multivariate regression analysis selected bicarbonate (F = 13.28) and Apo A-1/B levels (F = 6.58) as independent contributing variables. CONCLUSION: We found that insulin resistance correlated linearly with decline in renal function. Independent variables related to insulin resistance were bicarbonate and Apo A-1/B levels in patients with CKD.

Adult↗
PubMed2006

Local television news reporting of kidney disease.

BACKGROUND: Local television is the primary news source for the majority of Americans. This study aims to describe how local news reports on kidney disease. METHODS: Using our searchable database of health-related late local news segments from 2002, we identified stories with the key words kidney, hypertension, blood pressure, or diabetes. This database is a representative sample of the late local news on 122 stations in the 50 largest US media markets, comprising 60% of the population. The content of each identified story was reviewed to determine whether it mentioned: (1) chronic kidney disease (CKD), (2) screening for kidney disease, or (3) kidney disease as a potential complication (for blood pressure- or diabetes-related stories). RESULTS: Only 2 of 1,799 database news stories (0.11%) included "kidney" as a summary key word; neither referred to CKD, screening, or complications of other diseases. Of 19 stories about hypertension or blood pressure (1.06% of all stories) and the 14 stories about diabetes (0.78% of all stories), none mentioned these criteria. CONCLUSION: Despite efforts to increase public awareness of and screening for CKD, local television news (the most important news source for a majority of Americans) did little to help achieve these goals. Further work will be needed to confirm whether this paucity of coverage varies over time and determine why so little attention is given to CKD. Educating physicians and public relations personnel who advocate for kidney disease about journalists' needs may be an important step to help advance public awareness of CKD.

Health Education↗
PubMed2004

Translating research findings of chronic kidney disease management to clinical practice: Challenges and opportunities.

Chronic Kidney disease (CKD) has been identified as a public health epidemic, fueled in part by improved outcomes of both diabetic and cardiac patient populations, as well as by the increasing recognition that it is possible to identify CKD at earlier stages. The estimated 8 to 10 million Americans that have CKD, with its concomitant morbidity and mortality, have the potential to overwhelm the current system of specialty practice medicine and health care resources. How can clinicians, clinician scientists, and health care administrators translate research findings into clinical practice in an effective manner to improve the care of this burgeoning patient group? The challenge of translating research into clinical care requires identification of that which we do and do not know, communication of knowledge between those who do and do not know, and efficient collection of information for systematic evaluation. This article will describe the challenges of translating current research findings into clinical practice. There is a need to identify the complexity of CKD disease processes and issues associated with delivery of care and to describe the difficulties in the dissemination of new knowledge to physicians. Because of the propensity of CKD to affect identifiable groups of patients, we will discuss the potential challenges of these strategies given the racial, ethnic, and cultural diversity in North America. A potential solution to these challenges is a new paradigm of "process-based medicine" that integrates clinical and basic science research findings with multidisciplinary and shared care models of health care delivery. In this context, attention to advances in information technology, the cognitive processes that underlie physician learning, and the findings of outcome research may ensure true integration of clinical research and clinical practice.

Communication Barriers↗
PubMed2004

Energy requirements in patients with chronic kidney disease.

Knowledge concerning energy requirements of patients with chronic kidney disease (CKD) is important to providing a sufficient amount of energy to maintain adequate nutritional status for these patients. Data regarding energy expenditures of CKD patients are still scarce, and the results obtained are conflicting, with studies showing energy expenditures to be similar, higher, or lower than those of healthy individuals. More recently, studies focusing the role of the comorbidities and of the dialysis procedure on energy expenditure have been carried out, opening a new field of discussion that may help to clarify the profile of the energy expenditure of CKD patients. Another point of interest is related to the evaluation of energy intake. It has been shown that energy intake of CKD patients is lower than the 30 to 35 kcal/kg/day usually recommended. Although anorexia and consequently reduction of food intake is often present in these patients, a degree of underreporting in energy intake cannot be excluded. This review provides an overview of the studies that evaluated energy expenditures as well as those that studied the energy intakes and energy requirements of patients with CKD.

Calorimetry↗
PubMed2004

Osteoporosis and chronic kidney disease.

Bone disease is heterogenous and highly prevalent among those with chronic kidney disease, stage V (CKD-V) patients. Although we know much regarding the risk factors and outcomes associated with renal osteodystrophy, less is known about osteoporosis in CKD-V. Factors that predict bone loss in the CKD-V population are similar to those in the general population and include female gender, Caucasian race, older age, chronic disease, and immobility. In addition, some studies suggest that chronic acidosis and renal osteodystrophy may also increase the risk for bone loss. Little is known about associated adverse outcomes or the impact of therapeutic interventions for osteoporosis. Although we know that the risk for hip fracture is high among CKD-V patients and that fracture is associated with an increased risk for death, the role that bone loss plays is largely unknown. Current recommendations suggest that risk-factor modification is the most appropriate course of treatment for CKD-V-associated osteoporosis.

Absorptiometry, Photon↗
PubMed2006

Epidemiology of renal and cardiovascular risk factors in Toba Aborigines.

OBJECTIVES: To detect, educate, and control cardiovascular (CVD) risk factors, diabetes mellitus, hypertension, obesity, central obesity, and renal damage markers such as glomerular filtration rate (GFR) and proteinuria within a population of Toba aborigine people who live in the outskirts of Resistencia city, Chaco Province, Argentina. METHODS: A sample was selected from four Toba communities. Blood and urine samples were drawn in their own homes. Proteinuria was considered positive when a urinary protein/urinary creatinine rate (uPr/uCr) > or = 0.20. GFR was estimated by Levy formula, and the stages of chronic kidney disease (CKD) were as defined in the National Kidney Foundation Guidelines. RESULTS: In all, 385 subjects were included, 36% males, mean age = 36.1 years old. The prevalence of CVD risk factors was as follows: hypertension in 97 (25.2%), proteinuria in 84 (21.8%), CKD in 93 (24.2%) [Stage 1 in 26 (6.8%), Stage 2 in 46 (12%), and Stage 3 in 21 (5.5%)]. No subjects showed CKD Stage 4 or 5. Being overweight was found in 129 (33.5%), obesity in 82 (21.3%), central obesity in 190 (49.4%), and diabetes in 8 (2.1%). The presence of CKD was associated with an increased prevalence in central obesity, hypertension, and diabetes, but not obesity. The adjusted relative risk for proteinuria was 2.79 (p < or = 0.008) in subjects of at least 45 years of age, compared to subjects under 25 years. CONCLUSIONS: This group of aborigines showed a high prevalence of proteinuria and CVD risk factors and CKD not related to diabetes.

Adolescent↗