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Diabetes mellitus and CKD awareness: the Kidney Early Evaluation Program (KEEP) and National Health and Nutrition Examination Survey (NHANES).
Am J Kidney Dis. 2009 Apr; 53(4 Suppl 4):S11-21.AJ

Abstract

BACKGROUND

Diabetes contributes to increased morbidity and mortality in patients with chronic kidney disease (CKD). We sought to describe CKD awareness and identify factors associated with optimal glycemic control in diabetic and nondiabetic individuals both aware and unaware of CKD.

METHODS

This cross-sectional analysis compared Kidney Early Evaluation Program (KEEP) and National Health and Nutrition and Examination Survey (NHANES) 1999 to 2006 participants with diabetes and CKD. CKD was defined and staged using glomerular filtration rate (estimated by using the 4-variable Modification of Diet in Renal Disease Study equation) and urine albumin-creatinine ratio. NHANES defined diabetes as self-reported diabetes or fasting plasma blood glucose level of 126 mg/dL or greater, and KEEP as self-reported diabetes or diabetic retinopathy, use of diabetes medications, fasting blood glucose level of 126 mg/dL or greater, or nonfasting glucose level of 200 mg/dL or greater.

RESULTS

Of 77,077 KEEP participants, 20,200 (26.2%) were identified with CKD and 23,082 (29.9%) were identified with diabetes. Of 9,536 NHANES participants, 1,743 (18.3%) were identified with CKD and 1,127 (11.8%) were identified with diabetes. Of KEEP participants with diabetes and CKD (n = 7,853), 736 (9.4%) were aware of CKD. Trends in lack of CKD awareness were similar for KEEP participants with and without diabetes. Unaware participants with and without diabetes identified with stages 1 and 2 CKD were less likely to reach target glucose levels, defined as fasting glucose level less than 126 mg/dL or nonfasting glucose level less than 140 mg/dL, than those with stages 3 to 5 (odds ratio, 0.69; 95% confidence interval, 0.62 to 0.78; odds ratio, 0.69; 95% confidence interval, 0.58 to 0.81; P < 0.001, respectively).

CONCLUSION

Our data support that KEEP, as a targeted screening program, is a more enriched population with CKD and comorbid diabetes than NHANES. In addition, our findings highlight the relationship between dysglycemia and early stages of unidentified CKD.

Authors+Show Affiliations

Department of Internal Medicine, University of Missouri-Columbia School of Medicine and Harry S. Truman VA Medical Center, Columbia, MO 65212, USA. whaleyconnella@health.missouri.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19285607

Citation

Whaley-Connell, Adam, et al. "Diabetes Mellitus and CKD Awareness: the Kidney Early Evaluation Program (KEEP) and National Health and Nutrition Examination Survey (NHANES)." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 53, no. 4 Suppl 4, 2009, pp. S11-21.
Whaley-Connell A, Sowers JR, McCullough PA, et al. Diabetes mellitus and CKD awareness: the Kidney Early Evaluation Program (KEEP) and National Health and Nutrition Examination Survey (NHANES). Am J Kidney Dis. 2009;53(4 Suppl 4):S11-21.
Whaley-Connell, A., Sowers, J. R., McCullough, P. A., Roberts, T., McFarlane, S. I., Chen, S. C., Li, S., Wang, C., Collins, A. J., & Bakris, G. L. (2009). Diabetes mellitus and CKD awareness: the Kidney Early Evaluation Program (KEEP) and National Health and Nutrition Examination Survey (NHANES). American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 53(4 Suppl 4), S11-21. https://doi.org/10.1053/j.ajkd.2009.01.004
Whaley-Connell A, et al. Diabetes Mellitus and CKD Awareness: the Kidney Early Evaluation Program (KEEP) and National Health and Nutrition Examination Survey (NHANES). Am J Kidney Dis. 2009;53(4 Suppl 4):S11-21. PubMed PMID: 19285607.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diabetes mellitus and CKD awareness: the Kidney Early Evaluation Program (KEEP) and National Health and Nutrition Examination Survey (NHANES). AU - Whaley-Connell,Adam, AU - Sowers,James R, AU - McCullough,Peter A, AU - Roberts,Tricia, AU - McFarlane,Samy I, AU - Chen,Shu-Cheng, AU - Li,Suying, AU - Wang,Changchun, AU - Collins,Allan J, AU - Bakris,George L, AU - ,, PY - 2008/10/17/received PY - 2009/01/10/accepted PY - 2009/3/17/entrez PY - 2009/3/17/pubmed PY - 2009/4/25/medline SP - S11 EP - 21 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 53 IS - 4 Suppl 4 N2 - BACKGROUND: Diabetes contributes to increased morbidity and mortality in patients with chronic kidney disease (CKD). We sought to describe CKD awareness and identify factors associated with optimal glycemic control in diabetic and nondiabetic individuals both aware and unaware of CKD. METHODS: This cross-sectional analysis compared Kidney Early Evaluation Program (KEEP) and National Health and Nutrition and Examination Survey (NHANES) 1999 to 2006 participants with diabetes and CKD. CKD was defined and staged using glomerular filtration rate (estimated by using the 4-variable Modification of Diet in Renal Disease Study equation) and urine albumin-creatinine ratio. NHANES defined diabetes as self-reported diabetes or fasting plasma blood glucose level of 126 mg/dL or greater, and KEEP as self-reported diabetes or diabetic retinopathy, use of diabetes medications, fasting blood glucose level of 126 mg/dL or greater, or nonfasting glucose level of 200 mg/dL or greater. RESULTS: Of 77,077 KEEP participants, 20,200 (26.2%) were identified with CKD and 23,082 (29.9%) were identified with diabetes. Of 9,536 NHANES participants, 1,743 (18.3%) were identified with CKD and 1,127 (11.8%) were identified with diabetes. Of KEEP participants with diabetes and CKD (n = 7,853), 736 (9.4%) were aware of CKD. Trends in lack of CKD awareness were similar for KEEP participants with and without diabetes. Unaware participants with and without diabetes identified with stages 1 and 2 CKD were less likely to reach target glucose levels, defined as fasting glucose level less than 126 mg/dL or nonfasting glucose level less than 140 mg/dL, than those with stages 3 to 5 (odds ratio, 0.69; 95% confidence interval, 0.62 to 0.78; odds ratio, 0.69; 95% confidence interval, 0.58 to 0.81; P < 0.001, respectively). CONCLUSION: Our data support that KEEP, as a targeted screening program, is a more enriched population with CKD and comorbid diabetes than NHANES. In addition, our findings highlight the relationship between dysglycemia and early stages of unidentified CKD. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/19285607/Diabetes_mellitus_and_CKD_awareness:_the_Kidney_Early_Evaluation_Program__KEEP__and_National_Health_and_Nutrition_Examination_Survey__NHANES__ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(09)00035-3 DB - PRIME DP - Unbound Medicine ER -