title: Diabetes mellitus in CKD: Kidney Early Evaluation Program (KEEP) and National Health and Nutrition and Examination Survey (NHANES) 1999-2004.
abstract: BACKGROUND
  Diabetes mellitus is the leading cause of chronic kidney disease (CKD) and contributes to increased morbidity and mortality in the CKD population. Early diabetes identification through targeted screening programs is important for the development of preventive strategies.
  
  
  METHODS
  This is a cross-sectional analysis of the National Kidney Foundation Kidney Early Evaluation Program (KEEP) data and National Health and Nutrition and Examination Survey (NHANES) 1999-2004 data. KEEP is a community-based health-screening program enrolling individuals 18 years or older with diabetes, hypertension, or family history of kidney disease, diabetes, or hypertension. Study participants were those identified as meeting these inclusion criteria. Participants who had received kidney transplants or were currently receiving dialysis therapy were excluded.
  
  
  RESULTS
  Of 73,460 KEEP participants, 20,562 (28.0%) had diabetes compared with 1,545 of 17,049 (6.7%) NHANES participants. Age, obesity, high cholesterol level, hypertension, and cardiovascular disease distributions were similar for patients with diabetes in both populations, whereas women and African Americans were overrepresented in KEEP. The prevalence of diabetes in KEEP progressively increased with increasing stage of CKD, and this relationship persisted in subgroup analyses of older participants (age > 46 years), as well as in analyses stratified by sex, race, and other CKD risk factors: current tobacco use, obesity, hypertension, cardiovascular disease, and increased cholesterol level. KEEP participants with CKD who reported having diabetes were unlikely to have met target blood glucose levels (odds ratio, 0.71; 95% confidence interval, 0.66 to 0.77; P < 0.001). Reporting not having diabetes was associated with the likelihood of increased blood glucose levels (odds ratio, 1.28; 95% confidence interval, 1.16 to 1.41; P < 0.001).
  
  
  CONCLUSIONS
  KEEP is congruent with NHANES regarding a greater prevalence of diabetes in patients with CKD. As a targeted screening program, KEEP may represent a higher risk and more motivated patient population.
authors: University of Missouri-Columbia School of Medicine and Harry S Truman VA Medical Center, Columbia, MO 65212, USA. whaleyconnella@health.missouri.edu
authors: Adam T
authors: AT
authors: Whaley-Connell
authors: James R
authors: JR
authors: Sowers
authors: Samy I
authors: SI
authors: McFarlane
authors: Keith C
authors: KC
authors: Norris
authors: Shu-Cheng
authors: SC
authors: Chen
authors: Suying
authors: S
authors: Li
authors: Yang
authors: Y
authors: Qiu
authors: Changchun
authors: C
authors: Wang
authors: Lesley A
authors: LA
authors: Stevens
authors: Joseph A
authors: JA
authors: Vassalotti
authors: Allan J
authors: AJ
authors: Collins
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D015331:Cohort Studies; D003153:Community Health Services / Q000379:methods / Q000639:trends; D003430:Cross-Sectional Studies; D016208:Databases, Factual / Q000639:trends; D048909:Diabetes Complications / Q000175:diagnosis / Q000453:epidemiology*; D003928:Diabetic Nephropathies / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D042241:Early Diagnosis; D005260:Female; D005582:Foundations / Q000639:trends; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000639:trends; D008875:Middle Aged; D009749:Nutrition Surveys; D012307:Risk Factors; D014481:United States / Q000453:epidemiology