Standardization of Serum Creatinine and Estimated GFR in the Kidney Early Evaluation Program (KEEP)

Stevens, Lesley A.; Stoycheff, Nicholas

doi:10.1053/j.ajkd.2008.01.001

Cited by 43 publications

(32 citation statements)

References 12 publications

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“…Estimated glomerular filtration rate (eGFR) was calculated using the isotope dilution mass spectrometry (IDMS)-traceable version of the Modification of Diet in Renal Disease (MDRD) 4-variable study formula [12], and serum creatinine was calibrated according to the Cleveland Clinic Research Laboratory [13]. CKD stages were defined as follows: stage 1, eGFR ≥90 ml/min/1.73 m 2 and albumin-creatinine ratio ≥30 mg/g; stage 2, eGFR 60–89 ml/min/1.73 m 2 and albumin-creatinine ratio ≥30 mg/g; stage 3, eGFR 30–59 ml/min/1.73 m 2 ; stage 4, eGFR 15–29 ml/min/1.73 m 2 , and stage 5, eGFR <15 ml/min/1.73 m 2 .…”

Section: Methodsmentioning

confidence: 99%

Diabetic Cardiovascular Disease Predicts Chronic Kidney Disease Awareness in the Kidney Early Evaluation Program

et al. 2011

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Aims: Lack of chronic kidney disease (CKD) awareness is common. Recent data suggest that the presence of concurrent diabetes may heighten CKD awareness, but current data have not supported the hypothesis that healthcare delivery or insurance status improves awareness in the diabetic population. Diabetes is associated with high cardiovascular disease (CVD) morbidity, especially in patients with CKD. We hypothesized that a highly prevalent co-morbid condition such as CVD in patients with diabetes would predict CKD awareness. Methods: We utilized data from theNational Kidney Foundation-Kidney Early Evaluation Program (KEEP^TM), a large screening program designed to identify high-risk individuals for CKD and promote awareness. Results: Among 77,077 participants, CKD was identified in 20,200 and diabetes in 23,082. Prevalence of CVD was higher in participants with than without diabetes (39.5 vs. 22.0%) and in stage 3–5 compared to stage 1–2 CKD (43.3 vs. 34.4%). Patients with diabetes and CVD had a higher level of awareness than those without diabetes (8.2 vs. 2.2%). Among patients with diabetes and CVD, the presence of congestive heart failure was a better predictor of awareness [odds ratio (OR) 1.84; 95% confidence interval (CI) 1.40–2.43] than endpoints such as myocardial infarction or stroke [OR 1.35 (95% CI 1.04–1.73) and OR 1.34 (95% CI 1.04–1.72), respectively]. Conclusions: While prevalence of CKD awareness remained low, our data suggest that in patients with diabetes the presence of CVD was associated with increased awareness in a targeted screening program for CKD awareness.

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Section: Methodsmentioning

confidence: 99%

Diabetic Cardiovascular Disease Predicts Chronic Kidney Disease Awareness in the Kidney Early Evaluation Program

et al. 2011

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“…Furthermore, the kidney both filters and secretes creatinine. Finally, the assays used to measure creatinine have not be standardized across laboratories, therefore studies reporting values from multiple centers have inherent variation in values attributed to dif- Leads to generation of the hydroxyl radical, the most destructive of ROS; released into the blood in patients with ACS [64] ; thought to be involved in oxidative organ damage also in AKI [6] ; local cellular and tissue availability of catalytic iron are likely to determine the degree and severity of organ injury in the setting of most hypoxic and other toxic insults [66] In patients with ACS, the appearance of catalytic iron precedes the rise in serum troponin and detects acute myocardial infarction with an area under the ROC curve of > 90% [64] Detection of non-transferrinbound iron in blood by the bleomycin assay [64] Use of iron chelators to diminish oxidative injury [67] NGAL (lipocalin-2, siderocalin)…”

Section: Biomarkers Of Cardiorenal Syndromesmentioning

confidence: 99%

Cardiorenal syndromes

McCullough

Ahmad²

2011

WJC

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Cardiorenal syndromes (CRS) have been subclassified as five defined entities which represent clinical circumstances in which both the heart and the kidney are involved in a bidirectional injury and dysfunction via a final common pathway of cell-to-cell death and accelerated apoptosis mediated by oxidative stress. Types 1 and 2 involve acute and chronic cardiovascular disease (CVD) scenarios leading to acute kidney injury or accelerated chronic kidney disease. Types 2 and 3 describe acute and chronic kidney disease leading primarily to heart failure, although it is possible that acute coronary syndromes, stroke, and arrhythmias could be CVD outcomes in these forms of CRS. Finally, CRS type 5 describes a simultaneous insult to both heart and kidneys, such as sepsis, where both organs are injured simultaneously. Both blood and urine biomarkers are reviewed in this paper and offer a considerable opportunity to enhance the understanding of the pathophysiology and known epidemiology of these recently defined syndromes.

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“…Calcium levels were not corrected as albumin levels were not available in KEEP. eGFR was calculated by using the isotope dilution mass spectrometry-traceable 4-variable Modification of Diet in Renal Disease (MDRD) Study equation: (175 × [serum creatinine (mg/dl) –1.154 ] × [age (years) –0.203 ]) × (0.742 for women) × (1.21 for African Americans), as previously described [20]. Proteinuria was defined as a spot urine albumin to creatinine ratio ≥30 mg/g.…”

Section: Methodsmentioning

confidence: 99%

The Association between Parathyroid Hormone Levels and the Cardiorenal Metabolic Syndrome in Non-Diabetic Chronic Kidney Disease

et al. 2011

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Aims: The relationship between parathyroid hormone (PTH) and the cardiorenal metabolic syndrome was examined among non-diabetic persons with chronic kidney disease (CKD). Methods: In a cross-sectional analysis, the relationship between PTH levels and the cardiorenal metabolic syndrome was investigated in 3,215 non-diabetic participants in the National Kidney Foundation-Kidney Early Evaluation Program (KEEP 2.0) found to have CKD (eGFR <60 ml/min/1.73 m²). Results: In unadjusted analyses, the prevalence of the cardiorenal metabolic syndrome increased along increasing PTH quartiles (31.7, 33.8, 37.3, and 48.7%, respectively, p for trend <0.0001). After multivariate adjustment, as compared to the first PTH quartile, odds of the cardiorenal metabolic syndrome were 16% (p = 0.18), 35% (p = 0.006), and 80% (p < 0.0001) higher for the second, third, and fourth quartiles, respectively. When taken as a continuous predictor, each standard deviation increase of natural log transformed PTH was associated with 26% (p < 0.0001) higher odds of the cardiorenal metabolic syndrome. The association of PTH with the cardiorenal metabolic syndrome was not modified by age or gender (p for interaction was not significant for both modifiers). Conclusions: Among an outpatient non-diabetic population with CKD, higher PTH levels were associated with a higher prevalence of the cardiorenal metabolic syndrome.

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Standardization of Serum Creatinine and Estimated GFR in the Kidney Early Evaluation Program (KEEP)

Cited by 43 publications

References 12 publications

Diabetic Cardiovascular Disease Predicts Chronic Kidney Disease Awareness in the Kidney Early Evaluation Program

Diabetic Cardiovascular Disease Predicts Chronic Kidney Disease Awareness in the Kidney Early Evaluation Program

Cardiorenal syndromes

The Association between Parathyroid Hormone Levels and the Cardiorenal Metabolic Syndrome in Non-Diabetic Chronic Kidney Disease

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