Prevalence of Low Glomerular Filtration Rate in Nondiabetic Americans

Abstract

Abstract. End-stage renal disease is an important and costly health problem. Strategies for its prevention are urgently needed. Knowledge of the population-based prevalence of renal insufficiency in nondiabetic adults would inform such strategies. Black and white nondiabetic adult participants in the Third National Health and Nutrition Examination Survey were analyzed. The analysis was stratified by age, gender, and race, and four clinically applicable methods were used to assess renal function. There were 13,251 complete records for analysis. By the Modification of Diet in Renal Diseases (MDRD) GFR (GFR) prediction Equation 7, 58% (95% confidence interval [CI], 56 to 60%) of the total adult nondiabetic black and white US population had MDRD GFR below 80 ml/min per 1. . By the Cockcroft-Gault formula, the equivalent figures were 39% (95% CI, 37 to 41%), 14% (95% CI, 12% -16%), and 0.81% (95% CI, 0.46 to 1.2%), respectively. The findings of an unexpectedly high prevalence of low clearance and the increased prevalence of low clearance with age were consistent across the four clearance estimation methods used and for each race-sex stratum. The absolute magnitude of the prevalence of low clearance was, however, dependent on the clearance method used. Assessed by estimation from serum creatinine, low clearance may be very common, particularly with advancing age. The prognosis (in terms of risk for progression and end-stage renal disease) of low clearance in unreferred populations may differ from that in referred populations and requires further study.The incidence of end-stage renal disease (ESRD) increases annually in the United States and is projected to continue to increase over the next decade (1). ESRD is associated with increased morbidity (1) and with mortality comparable with that of common malignancies (2). Improving outcomes for patients at risk of ESRD is an important mandate for primary care practitioners, generalists, and nephrologists. There is compelling evidence that BP control and angiotensin-converting enzyme (ACE) inhibitor use reduce the rate of progression of chronic renal insufficiency (CRI) (3-7) and should reduce the number of patients with ESRD. Referral to a nephrologist several months before the initiation of dialysis is associated with lower morbidity on dialysis and improved outcomes (8 -11) but is underutilized (12).Strategies to enhance implementation of these approaches are needed. Guidelines for the appropriate management and referral of patients with CRI have been developed in Canada (13), and they are under development in the US (the Kidney Disease Outcomes Quality Initiative [K/DOQI]) (14). To be feasible and effective, recommendations about suitable strategies must take the prevalence of renal insufficiency into account. The population prevalence for elevated creatinine (Ͼ1.5 mg/dl in men; Ͼ1.4 mg/dl in women) has been estimated at 8.0% of men and 8.9% of women by Culleton et al. (15) in Framingham Heart Study participants. Nissenson et al. (16), using data from a large US health...

Development Of Chronic Kidney Disease and Cardiovascular Prognosis in Essential Hypertensive Patients

“…We have recently described that 7.6% of patients referred to our hypertension unit have a decreased renal function according to serum creatinine levels, and one of every four patients has a decreased creatinine clearance (12). The prevalence of CKD in the community could be even higher according to the values of estimated creatinine clearance seen in the Third National Health and Nutrition Examination Survey (NHANES III) (7,22).…”

Association of High Serum Creatinine and Anemia Increases the Risk of Coronary Events

“…However, direct measurements of GFR using inulin or iothalamate are not feasible in a large population-based study such as ARIC. Moreover, the use of the MDRD or the Cockroft-Gault equations to estimate GFR can result in misclassification of subjects according to their kidney function status as a result of differences in Scr calibration from one laboratory to the other (44,47,48). Although some authors have suggested applying a calibration factor to Scr values when using the MDRD equation to reduce the misclassification bias (35,44,49), we decided to base our analysis only on the crude Scr levels for two reasons.…”

Recognition and Management of Chronic Kidney Disease in an Elderly Ambulatory Population

“…1, 2 The early recognition of kidney disease is important because medical interventions, including the use of angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), can slow the progression of disease. [3][4][5] Detection is challenging because serum creatinine, although convenient to measure, performs poorly in diagnosing CKD in the elderly, for whom significant declines in glomerular filtration rate (GFR) can be obscured owing to the effects of age, weight, muscle mass, race, and sex.…”