American Journal of Kidney Diseases
Volume 52, Issue 2 , Pages 382-383, August 2008

CKD Awareness in the United States: The Kidney Early Evaluation Program (KEEP)

Article Outline

 

To the Editor:

Chronic kidney disease (CKD) is silent until advanced stages and therefore many individuals are unaware of its presence and detection often occurs only shortly before onset of symptomatic uremia. Thereby, awareness and detection of CKD at earlier stages would allow more time for evaluation and treatment. The Kidney Early Evaluation Program (KEEP) is the first national health screening program to target adult populations at high risk for CKD and promote awareness.

Previous population-based surveys have suggested that most patients with CKD have not effectively been informed of their condition by their medical professional.1, 2 Unlike KEEP, these surveys were not designed to specifically target patients at risk for CKD. We sought to determine how many patients identified as having CKD through the KEEP screening had been told by a physician they had kidney disease prior to screening and advised to follow its progress.

The KEEP methods, including CKD definition, have been described previously.3, 4 Data were examined from August 1, 2000 to December 31, 2005. While most (90%) patients found to have CKD had seen a physician within the previous year, awareness of kidney disease was low for all stages of CKD (Table 1). We then examined CKD awareness pre-2003 and compared it to 2003 and onwards. For CKD stages 1 to 3, awareness increased slightly (4.1% [95% confidence interval (CI), 3.4% to 4.9%] versus 5.5% [95% CI, 5.0% to 5.9%, P < 0.01]), while awareness for CKD stages 4 to 5 had a more profound increase (19.7% [95% CI, 13.0% to 26.4%] versus 39.4% [95% CI, 34.4% to 44.4%], P < 0.001).

Table 1. Awareness of CKD per CKD Stage
Stage 1 and ACR > 30 mg/gStage 2 and ACR > 30 mg/gStage 3Stage 4Stage 5
2000–2005
Number1,3772,1598,86642778
% Aware4.36(3.28–5.77)4.86(3.96–5.77)5.39(4.92–5.86)32.08(27.65–36.53)44.87(33.76–55.98)
2000–2002
Number1903132,11311225
% Aware3.16(0.66–5.65)2.56(0.80–4.31)4.45(3.57–5.33)15.18(8.50–21.85)40.00(20.40–60.74)
2003–2005
Number1,1871,8466,75331553
% Aware4.55(3.36–5.74)5.25(4.24–6.27)5.69(5.13–6.24)38.10(32.72–43.47)47.10(33.60–60.74)

Note: Values shown are number or percent (95% confidence interval); awareness defined as a positive response to the question “Have you ever been told you have kidney disease?” Albumin-creatinine ratio in mg/g may be converted to mg/mmol by dividing by 8.84.

Abbreviation: ACR, albumin-creatinine ratio.

While our data indicate that awareness of CKD among patients participating in the screening program has increased since 2003, the results still suggest that even patients at high risk for CKD are not being effectively informed and made aware of their condition. This occurred despite most participants seeing a physician within the previous year. Given that the US prevalence of CKD is increasing5 and is an independent predictor of poor outcomes,6 further measures are needed to enhance CKD detection and education in the United States.

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Acknowledgements 

The authors would like to thank the following for their contributions to this manuscript: Monica Gannon, BA; Michael G. Shlipak, MD; Keith C. Norris, MD; Allan J. Collins, MD; James R. Sowers, MD; Samy I. McFarlane, MD; Suying Li, PhD; and Shu-Cheng Chen, MS.

Support: The Kidney Early Evaluation Program (KEEP) is a program of the National Kidney Foundation, Inc, and is supported by Amgen, Abbott, Genzyme, Ortho Biotech Projects, LP, and Novartis, with additional support provided by Siemens Medical Solutions Diagnostics, Lifescan, Suplena, and OceanSpray Cranberries.

Financial Disclosure: None.

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References 

  1. Coresh J, Byrd-Holt D, Astor BC, et al. Chronic kidney disease awareness, prevalence, and trends among U.S. adults, 1999 to 2000. J Am Soc Nephrol. 2005;16:180–188
  2. Nickolas TL, Frisch GD, Opotowsky AR, et al. Awareness of kidney disease in the US population: findings from the National Health and Nutrition Examination Survey (NHANES) 1999 to 2000. Am J Kidney Dis. 2004;44:185–197
  3. Jurkovitz CT, Qiu Y, Wang C, et al. The Kidney Early Evaluation Program (KEEP): program design and demographic characteristics of the population. Am J Kidney Dis. 2008;51(suppl 2):S3–S12
  4. Whaley-Connell AT, Sowers JR, Stevens LA, et al. CKD in the United States: Kidney Early Evaluation Program (KEEP) and National Health and Nutrition Examination Survey (NHANES) 1999-2004. Am J Kidney Dis. 2008;51(suppl 2):S13–S20
  5. Coresh J, Selvin E, Stevens LA, et al. Prevalence of chronic kidney disease in the United States. JAMA. 2007;298:2038–2047
  6. Go AS, Chertow GM, Fan D, et al. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351:1296–1305

PII: S0272-6386(08)00998-0

doi:10.1053/j.ajkd.2008.05.026

American Journal of Kidney Diseases
Volume 52, Issue 2 , Pages 382-383, August 2008

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