Original investigation: pathogenesis and treatment of kidney disease and hypertension
Early detection of kidney disease in community settings: the kidney early evaluation program (KEEP)

https://doi.org/10.1016/S0272-6386(03)00405-0Get rights and content

Abstract

Background:

Early identification of persons at risk for kidney disease provides an opportunity to prevent or delay its progression and decrease morbidity and mortality. Our hypothesis was that implementation of a targeted screening program in communities with high-risk populations would detect previously unidentified persons with or at high risk for chronic kidney disease (CKD) with a prevalence that exceeds that predicted for CKD in the general population.

Methods:

Persons with hypertension or diabetes or a first-order relative with hypertension, diabetes, or kidney disease were screened for kidney disease risk factors. Blood pressure, blood glucose level, serum creatinine level, hemoglobin level, microalbuminuria, hematuria, pyuria, body mass index, and estimated glomerular filtration rate (EGFR) were evaluated.

Results:

Six thousand seventy-one eligible persons were screened from August 2000 through December 2001: of these persons, 68% were women, 43% were African American, 36% were white, 10% were Hispanic, and 5% were Native American. Most reported high-school education or more (84%) and health insurance coverage (86%). Twenty-seven percent met the screening definitions for diabetes; 64%, for hypertension; 29%, for microalbuminuria; 8%, for anemia; 18%, for hematuria; 13%, for pyuria; 5%, for elevated serum creatinine level; 16%, for reduced EGFR; and 44%, for obesity. Among participants without a reported history of specified conditions, screening identified 82 participants (2%) with diabetes, 1,014 participants (35%) with hypertension, 277 participants (5%) with elevated serum creatinine levels, 839 participants (14%) with reduced EGFRs, and 1,712 participants (29%) with microalbuminuria. Thirty-five percent of participants with a history of diabetes had elevated serum glucose levels at screening (≥180 mg/dL [10 mmol/L]), and 64% with a history of hypertension did not have blood pressure controlled to less than 140/90 mm Hg. Only 18% of participants with a history of diabetes and 31% with a reduced EGFR had blood pressure controlled to less than 130/80 mm Hg and less than 135/85 mm Hg, respectively.

Conclusion:

Targeted screening is effective in identifying persons with previously unidentified or poorly controlled kidney disease risk factors, as well as persons with a moderately decreased EGFR.

Section snippets

Participant recruitment

National Kidney Foundation (NKF) affiliates conducted 135 KEEP screening programs in 33 states. Screenings were advertised through local media (radio and television stations, newspapers), announcements by clergy from the pulpit, flyers, posters, and information provided to dialysis patients, with an emphasis on minority communities. Screening sites included churches, hospitals, health centers, schools, community centers, and dialysis units. Eligibility criteria for screening were age of 18

Sociodemographic characteristics of participants

Of 6,851 individuals who attended the screening programs, 6,071 people were eligible for inclusion in this analysis based on inclusion criteria (Fig 1). Demographic and lifestyle data are listed in Table 1. Participants screened during the first 17 months of the KEEP program were predominately African American, women, middle aged (mean age, 52 ± 15.6 [SD] years; range, 18 to 101 years), well educated, with some form of health insurance, and with access to health care providers.

Discussion

The worldwide epidemic of ESRD has led to concerns about the burden of mild to moderate CKD in the general population.2, 30 Mild CKD appears to be very common, as recently reported in the NKF K/DOQI guidelines.2, 4, 30 The adverse outcomes of CKD can be prevented or delayed through early detection and early intervention strategies. The KEEP 2.0 program shows the effectiveness of community-based targeted health screening programs in identifying large numbers of individuals at high risk for

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    The Kidney Early Evaluation Program (KEEP) is a program of the National Kidney Foundation, Inc. KEEP was supported by Ortho Biotech Products, LP, with additional support from Bayer Diagnostics; Satellite Laboratory Services of Redwood City, CA; Satellite Healthcare; and Ocean Spray.

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