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Original Investigations: Pathogenesis and Treatment of Kidney Disease and Hypertension| Volume 41, ISSUE 1, P1-12, January 01, 2003

Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third national health and nutrition examination survey

  • Josef Coresh
    Affiliations
    Departments of Epidemiology and Biostatistics, Bloomberg School of Public Health; Welch Center for Prevention, Epidemiology and Clinical Research; Department of Medicine, School of Medicine, The Johns Hopkins University, Baltimore, MD; Department of Biostatistics and Epidemiology, Cleveland Clinic Foundation, Cleveland, OH; Department of Medicine, Baylor College of Medicine, Houston, TX; and the Department of Medicine, Tufts University School of Medicine, Division of Nephrology, New England Medical Center Hospital, Boston, MA.
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  • Brad C. Astor
    Affiliations
    Departments of Epidemiology and Biostatistics, Bloomberg School of Public Health; Welch Center for Prevention, Epidemiology and Clinical Research; Department of Medicine, School of Medicine, The Johns Hopkins University, Baltimore, MD; Department of Biostatistics and Epidemiology, Cleveland Clinic Foundation, Cleveland, OH; Department of Medicine, Baylor College of Medicine, Houston, TX; and the Department of Medicine, Tufts University School of Medicine, Division of Nephrology, New England Medical Center Hospital, Boston, MA.
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  • Tom Greene
    Affiliations
    Departments of Epidemiology and Biostatistics, Bloomberg School of Public Health; Welch Center for Prevention, Epidemiology and Clinical Research; Department of Medicine, School of Medicine, The Johns Hopkins University, Baltimore, MD; Department of Biostatistics and Epidemiology, Cleveland Clinic Foundation, Cleveland, OH; Department of Medicine, Baylor College of Medicine, Houston, TX; and the Department of Medicine, Tufts University School of Medicine, Division of Nephrology, New England Medical Center Hospital, Boston, MA.
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  • Garabed Eknoyan
    Affiliations
    Departments of Epidemiology and Biostatistics, Bloomberg School of Public Health; Welch Center for Prevention, Epidemiology and Clinical Research; Department of Medicine, School of Medicine, The Johns Hopkins University, Baltimore, MD; Department of Biostatistics and Epidemiology, Cleveland Clinic Foundation, Cleveland, OH; Department of Medicine, Baylor College of Medicine, Houston, TX; and the Department of Medicine, Tufts University School of Medicine, Division of Nephrology, New England Medical Center Hospital, Boston, MA.
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  • Andrew S. Levey
    Affiliations
    Departments of Epidemiology and Biostatistics, Bloomberg School of Public Health; Welch Center for Prevention, Epidemiology and Clinical Research; Department of Medicine, School of Medicine, The Johns Hopkins University, Baltimore, MD; Department of Biostatistics and Epidemiology, Cleveland Clinic Foundation, Cleveland, OH; Department of Medicine, Baylor College of Medicine, Houston, TX; and the Department of Medicine, Tufts University School of Medicine, Division of Nephrology, New England Medical Center Hospital, Boston, MA.
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      Abstract

      Background: Recently developed clinical practice guidelines and calibration of the Third National Health and Nutrition Examination Survey (NHANES III) serum creatinine assay provide a basis for estimating the prevalence and distribution of chronic kidney disease (CKD) in the United States using standardized criteria based on estimated glomerular filtration rate (GFR) and persistent albuminuria. Methods: A nationally representative sample of 15,625 noninstitutionalized adults aged 20 years and older from the NHANES III was analyzed. Kidney function (GFR), kidney damage (albuminuria), and stages of CKD (GFR and albuminuria) were estimated from calibrated serum creatinine level, spot urine albumin level, age, sex, and race. GFR was estimated using the simplified Modification of Diet in Renal Disease Study equation and compared with the Cockcroft-Gault equation for creatinine clearance (CCr). Results: The prevalence of CKD in the US adult population was 11% (19.2 million). By stage, an estimated 5.9 million individuals (3.3%) had stage 1 (persistent albuminuria with a normal GFR), 5.3 million (3.0%) had stage 2 (persistent albuminuria with a GFR of 60 to 89 mL/min/1.73 m2), 7.6 million (4.3%) had stage 3 (GFR, 30 to 59 mL/min/1.73 m2), 400,000 individuals (0.2%) had stage 4 (GFR, 15 to 29 mL/min/1.73 m2), and 300,000 individuals (0.2%) had stage 5, or kidney failure. Aside from hypertension and diabetes, age is a key predictor of CKD, and 11% of individuals older than 65 years without hypertension or diabetes had stage 3 or worse CKD. Compared with GFR estimates, CCr estimates showed a steeper decline with age and were lower in non-Hispanic blacks. Conclusion: CKD is common and warrants improved detection and classification using standardized criteria to improve outcomes. Am J Kidney Dis 41:1-12. © 2003 by the National Kidney Foundation, Inc.

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