KEEP 2010
Comparison of the CKD Epidemiology Collaboration (CKD-EPI) and Modification of Diet in Renal Disease (MDRD) Study Equations: Prevalence of and Risk Factors for Diabetes Mellitus in CKD in the Kidney Early Evaluation Program (KEEP)

https://doi.org/10.1053/j.ajkd.2010.11.009Get rights and content

Background

Diabetes is a leading cause of chronic kidney disease (CKD). Whether reclassification of CKD stages based on glomerular filtration rate estimated using the CKD Epidemiology Collaboration (CKD-EPI) equation versus the Modification of Diet in Renal Disease (MDRD) Study equation modifies estimates of prevalent risk factors across stages is unknown.

Methods

This is a cross-sectional analysis of data from the Kidney Early Evaluation Program (KEEP), a community-based health screening program targeting individuals 18 years and older with diabetes, hypertension, or a family history of diabetes, hypertension, or kidney disease. Of 109,055 participants, 68.2% were women and 31.8% were African American. Mean age was 55.3 ± 0.05 years. Clinical, demographic, and laboratory data were collected from August 2000 through December 2009. Glomerular filtration rate was estimated using the CKD-EPI and MDRD Study equations.

Results

CKD was present in 25.6% and 23.5% of the study population using the MDRD Study and CKD-EPI equations, respectively. Diabetes was present in 42.4% and 43.8% of participants with CKD, respectively. Prevalent risk factors for diabetes included obesity (body mass index >30 kg/m2), 44.0%; hypertension, 80.5%; cardiovascular disease, 23.2%; family history of diabetes, 55.9%; and dyslipidemia, 43.0%. In a logistic regression model after adjusting for age and other risk factors, odds for diabetes increased significantly compared with no CKD with each CKD stage based on the CKD-EPI equation and similarly with stages based on the MDRD Study equation. Using a CKD-EPI–adjusted model, ORs were: stage 1, 2.08 (95% CI, 1.90-2.27); stage 2, 1.86 (95% CI, 1.72-2.02); stage 3, 1.23 (95% CI, 1.17-1.30); stage 4, 1.69 (95% CI, 1.42-2.03); and stage 5, 2.46 (95% CI, 1.46-4.14).

Conclusions

Using the CKD-EPI equation led to a lower prevalence of CKD but to similar diabetes prevalence rates associated with CKD across all stages compared with the MDRD Study equation. Diabetes and other CKD risk factor prevalence was increased compared with the non-CKD population.

Section snippets

Study Participants

KEEP is a free community-based health screening program targeting individuals 18 years and older with diabetes, hypertension, or a family history of diabetes, hypertension, or kidney disease. We included 123,704 eligible KEEP participants from August 2000 through December 31, 2009, from 48 National Kidney Foundation affiliates and 2,634 screening programs in 50 states and the District of Columbia. We excluded participants who previously had undergone dialysis or kidney transplant or whose

Demographics of the Study Population

For the included 109,055 eligible KEEP participants, demographic, clinical, and laboratory data were collected between August 2000 and December 31, 2009. Mean age was 55.3 ± 0.05 years. Mean body mass index (BMI) was 30.2 ± 0.02 kg/m2. Of the total cohort, 68.2% were women; 31.8% were African American, 49.7% were white, and 11.9% were Hispanic.

Demographics and Prevalence of and Risk Factors for Diabetes

Of 109,055 participants, 34,144 (31.3%) had diabetes. Mean fasting blood glucose level was 94.7 ± 0.1 mg/dL for nondiabetic and 138.5 ± 0.71 mg/dL for

Discussion

Although several studies show a high prevalence of diabetes in patients with advanced CKD (eGFR <60 mL/min/1.73 m2),5, 9, 15 this analysis is among the first to describe a high prevalence of diabetes in earlier stages of CKD using the CKD-EPI equation to estimate GFR. Our data suggest that increases in diabetes prevalence were similar in participants identified with CKD and across stages using the CKD-EPI and MDRD Study equations. Our data further suggest that using the CDK-EPI equation to

Acknowledgements

The KEEP Steering Committee comprises: George Bakris, MD, FACP, FASN; Peter McCullough, MD, MPH; Andrew Bomback, MD; Claudine Jurkovitz, MD, MPH; Bryan Kestenbaum, MD; Louis Kuritzky, MD; Samy McFarlane, MD, MPH, FACP; Rajendra H. Mehta, MD; Keith Norris, MD; Michael Shlipak, MD, MPH; James Sowers, MD; Manjula Kurella Tamura, MD, MPH; Lesley Stevens, MD, MS; Adam Whaley-Connell, DO, MSPH; Ex-Officio: Bryan Becker, MD; Allan Collins, MD, FACP; Andrew Narva, MD, FACP; Nilka Rios Burrows, MPH;

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