Diabetes Mellitus in CKD: Kidney Early Evaluation Program (KEEP) and National Health and Nutrition and Examination Survey (NHANES) 1999-2004
Received 7 November 2007; accepted 11 December 2007.
Background
Diabetes mellitus is the leading cause of chronic kidney disease (CKD) and contributes to increased morbidity and mortality in the CKD population. Early diabetes identification through targeted screening programs is important for the development of preventive strategies.
Methods
This is a cross-sectional analysis of the National Kidney Foundation Kidney Early Evaluation Program (KEEP) data and National Health and Nutrition and Examination Survey (NHANES) 1999-2004 data. KEEP is a community-based health-screening program enrolling individuals 18 years or older with diabetes, hypertension, or family history of kidney disease, diabetes, or hypertension. Study participants were those identified as meeting these inclusion criteria. Participants who had received kidney transplants or were currently receiving dialysis therapy were excluded.
Results
Of 73,460 KEEP participants, 20,562 (28.0%) had diabetes compared with 1,545 of 17,049 (6.7%) NHANES participants. Age, obesity, high cholesterol level, hypertension, and cardiovascular disease distributions were similar for patients with diabetes in both populations, whereas women and African Americans were overrepresented in KEEP. The prevalence of diabetes in KEEP progressively increased with increasing stage of CKD, and this relationship persisted in subgroup analyses of older participants (age > 46 years), as well as in analyses stratified by sex, race, and other CKD risk factors: current tobacco use, obesity, hypertension, cardiovascular disease, and increased cholesterol level. KEEP participants with CKD who reported having diabetes were unlikely to have met target blood glucose levels (odds ratio, 0.71; 95% confidence interval, 0.66 to 0.77; P < 0.001). Reporting not having diabetes was associated with the likelihood of increased blood glucose levels (odds ratio, 1.28; 95% confidence interval, 1.16 to 1.41; P < 0.001).
Conclusion
KEEP is congruent with NHANES regarding a greater prevalence of diabetes in patients with CKD. As a targeted screening program, KEEP may represent a higher risk and more motivated patient population.
8Department of Medicine, Division of Nephrology, Mount Sinai School of Medicine, New York, NY.
Address correspondence to Adam T. Whaley-Connell, DO, MSPH, Assistant Professor of Medicine, University of Missouri-Columbia School of Medicine, Department of Internal Medicine, Division of Nephrology, MA436, DC043.0, One Hospital Dr, Columbia, MO 65212.
A list of the members of the Kidney Early Evaluation Program Investigators appears at the end of this article.
ABSTRACT