ORIGINAL ARTICLECardiovascular Risk Factor Profiles and Kidney Function Stage in the US General Population: The NHANES III Study
Section snippets
SUBJECTS AND METHODS
A preliminary report of the Third National Health and Nutrition Examination Survey (NHANES III) data,13 not subject to the formal peer-review process, was published previously by the authors of the current study. The current article represents additional analysis of these data.
RESULTS
The median (interquartile range) age of the 15,837 study subjects was 40.7 (30.3-56.7) years; 52.1% were women, 10.4% were African American, and 5.1% were Mexican American; 23.8%, 11.3%, and 5.4% had self-reported hypertension, cardiovascular disease, and diabetes mellitus, respectively. The median (interquartile range) year of education was 11.8 (11.0-14.0), 87.8% of subjects had insurance coverage, and family income was less than $10,000 in 11.1% and at least $50,000 in 23.7%. Each of these
DISCUSSION
We found that abnormalities of estimated GFR were common. We also found that the prevalence of cardiovascular risk factors increased with stage of kidney dysfunction, especially as the GFR decreased lower than 60 mL/min per 1.73 m2. Even when adjustments were made for age, race, self-reported hypertension, self-reported cardiovascular disease, self-reported diabetes mellitus, and other demographic characteristics, a relatively robust association persisted between the overall burden of
CONCLUSION
We believe that our study has useful features and raises important questions. This community-based random sample of the entire US population supports the notion that CKD is much more common than previously thought. It also suggests that undertreated cardiovascular risk factors are overrepresented, even in those who would not typically receive specialist care. Subjects with CKD appear much more likely to need multiple cardiovascular risk factor interventions than those without CKD. Strategies
Acknowledgments
We thank Beth Forrest and James Kaufmann, PhD, for assistance with preparation and editing, respectively, of the submitted manuscript.
REFERENCES (42)
- et al.
Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey
Am J Kidney Dis
(2003) - et al.
Cardiovascular disease and chronic renal disease: a new paradigm
Am J Kidney Dis
(2000) - et al.
Cardiovascular disease and mortality in a community-based cohort with mild renal insufficiency
Kidney Int
(1999) - et al.
Moderate renal insufficiency and the risk of cardiovascular mortality: results from the NHANES I
Kidney Int
(2002) - et al.
Level of kidney function as a risk factor for cardiovascular outcomes in the elderly
Kidney Int
(2003) - et al.
Serum ascorbic acid and cardiovascular disease prevalence in U.S. adults: the Third National Health and Nutrition Examination Survey (NHANES III)
Ann Epidemiol
(1999) - et al.
Calibration and random variation of the serum creatinine assay as critical elements of using equations to estimate glomerular filtration rate
Am J Kidney Dis
(2002) - et al.
Anemia as a risk factor for cardiovascular disease in the Atherosclerosis Risk in Communities (ARIC) study
J Am Coll Cardiol
(2002) - et al.
Proteinuria, albuminuria, risk, assessment, detection, elimination (PARADE): a position paper of the National Kidney Foundation
Am J Kidney Dis
(1999) - et al.
Epidemiological evaluation of known and suspected cardiovascular risk factors in chronic renal impairment
Am J Kidney Dis
(2001)
Cardiovascular risk factors in predialysis patients: baseline data from the Chronic Renal Impairment in Birmingham (CRIB) study
Kidney Int Suppl
Cardiac risk factors and the use of cardioprotective medications in patients with chronic renal insufficiency
Am J Kidney Dis
Cardiovascular disease risk status in elderly persons with renal insufficiency
Kidney Int
Plasma amino acid abnormalities in chronic renal failure
Clin Chim Acta
C-reactive protein is associated with renal function abnormalities in a nondiabetic population
Kidney Int
Effect of homocysteine-lowering treatment with folic acid plus vitamin B6 on progression of subclinical atherosclerosis: a randomised, placebo-controlled trial
Lancet
Differential hs-CRP reduction in patients with familial hypercholesterolemia treated with aggressive or conventional statin therapy
Atherosclerosis
K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification
Am J Kidney Dis
Chronic renal diseases: renoprotective benefits of renin-angiotensin system inhibition
Ann Intern Med
National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification [published correction appears in Ann Intern Med. 2003;139:605]
Ann Intern Med
Renal insufficiency as a predictor of cardiovascular outcomes and the impact of ramipril: the HOPE randomized trial
Ann Intern Med
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The data reported herein have been analyzed by the US Renal Data System using National Health and Nutrition Examination Survey files available for public use. This study was performed as a deliverable under Contract No. N01-DK-9-2343 (National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Md).
Individual reprints of this article are not available.