Elsevier

Mayo Clinic Proceedings

Volume 80, Issue 10, October 2005, Pages 1270-1277
Mayo Clinic Proceedings

ORIGINAL ARTICLE
Cardiovascular Risk Factor Profiles and Kidney Function Stage in the US General Population: The NHANES III Study

https://doi.org/10.4065/80.10.1270Get rights and content

OBJECTIVE

To determine the prevalence of cardiovascular risk factors in the general population based on kidney function.

SUBJECTS AND METHODS

We retrospectively analyzed data from the Third National Health and Nutrition Examination Survey of noninstitutionalized US adults, which was conducted from 1988 to 1994. Data were gathered on 9 cardiovascular risk factors (smoking; obesity; hypertension; high total cholesterol, C-reactive protein, glycosylated hemoglobin, and homocysteine levels; low hemoglobin level; and high urinary albumin-to-creatinine ratio) and estimated glomerular filtration rate (GFR).

RESULTS

For the 15,837 subjects, the estimated GFR was at least 90 mL/min per 1.73 m2 (normal) in 65.4%, 60 to 89.9 mL/min per 1.73 m2 (stage 2 kidney function) in 27.9%, 30 to 59.9 mL/min per 1.73 m2 (stage 3 kidney function) in 6.2%, and less than 30 mL/min per 1.73 m2 (stages 4 and 5 kidney function) in 0.5%. The number of cardiovascular risk factors increased with stage of kidney dysfunction. Of subjects with a normal GFR, 30.4% had no risk factors, 34.9% had 1 risk factor, and 34.7% had 2 or more risk factors. Of subjects with stage 2 kidney function, 24.8% had no risk factors, 30.3% had 1 risk factor, and 44.9% had 2 or more risk factors. Of subjects with stage 3 kidney function, 1.4% had no risk factors, 14.9% had 1 risk factor, and 83.6% had 2 or more risk factors. All subjects with stages 4 and 5 kidney function had 2 or more risk factors. After covariate adjustment, odds ratios for having an estimated GFR lower than 60 mL/min per 1.73 m2 were 1, 3.7 (95% confidence interval, 1.2-11.3), and 10.4 (95% confidence interval, 3.9-27.8) times greater in subjects with 0, 1, and 2 or more cardiovascular risk factors, respectively (P≤.001).

CONCLUSION

Persons with chronic kidney disease are much more likely to need multiple cardiovascular risk factor interventions than those without chronic kidney disease.

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)

  • DC Wheeler et al.

    Cardiovascular risk factors in predialysis patients: baseline data from the Chronic Renal Impairment in Birmingham (CRIB) study

    Kidney Int Suppl

    (May 2003)
  • M Tonelli et al.

    Cardiac risk factors and the use of cardioprotective medications in patients with chronic renal insufficiency

    Am J Kidney Dis

    (2001)
  • MG Shlipak et al.

    Cardiovascular disease risk status in elderly persons with renal insufficiency

    Kidney Int

    (2002)
  • AJ Robins et al.

    Plasma amino acid abnormalities in chronic renal failure

    Clin Chim Acta

    (1972)
  • EM Stuveling et al.

    C-reactive protein is associated with renal function abnormalities in a nondiabetic population

    Kidney Int

    (2003)
  • EG Vermeulen et al.

    Effect of homocysteine-lowering treatment with folic acid plus vitamin B6 on progression of subclinical atherosclerosis: a randomised, placebo-controlled trial

    Lancet

    (2000)
  • S van Wissen et al.

    Differential hs-CRP reduction in patients with familial hypercholesterolemia treated with aggressive or conventional statin therapy

    Atherosclerosis

    (2002)
  • National Kidney Foundation

    K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification

    Am J Kidney Dis

    (2002)
  • G Remuzzi et al.

    Chronic renal diseases: renoprotective benefits of renin-angiotensin system inhibition

    Ann Intern Med

    (2002)
  • AS Levey et al.

    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

    (2003)
  • JF Mann et al.

    Renal insufficiency as a predictor of cardiovascular outcomes and the impact of ramipril: the HOPE randomized trial

    Ann Intern Med

    (2001)
  • Cited by (134)

    • Light wine consumption is associated with a lower odd for cardiovascular disease in chronic kidney disease

      2018, Nutrition, Metabolism and Cardiovascular Diseases
      Citation Excerpt :

      While dialysis or transplantation may result from CKD, the majority of CKD patients will die prematurely from cardiovascular disease (CVD) prior to reaching this end-point [2–4]. Importantly, CKD is associated with increased cardiovascular mortality partially due to increased prevalence of traditional risk factors such as age, diabetes mellitus, hypertension, and hyperlipidemia in patients with CKD [5,6]. However, CKD is also associated with an increased prevalence of nontraditional risk factors unique to this patient population such retention of uremic toxins, anemia, abnormalities in bone mineral metabolism, and increased inflammatory states which likely contribute to the higher risk of CVD in CKD [7–10].

    • The Role of the Chronic Kidney Disease Clinic and Multidisciplinary Team Care

      2018, Chronic Kidney Disease, Dialysis, and Transplantation: A Companion to Brenner and Rector’s The Kidney
    • Kidney Disease and Psoriasis. A New Comorbidity?

      2016, Actas Dermo-Sifiliograficas
    View all citing articles on Scopus

    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.

    View full text