title: Screening for chronic kidney disease complications in US adults: racial implications of a single GFR threshold.
abstract: OBJECTIVE
  An ideal and effective screening tool should perform equally across ethnic groups. The objective of this study was to determine whether the widely advocated creatinine-based estimated GFR (eGFR) threshold of 60 ml/min per 1.73 m(2) identifies the typical metabolic abnormalities related to chronic kidney disease equally well in minority and nonminority adults.
  
  
  METHODS
  This objective was addressed using data for 8918 minority and nonminority adult participants in the National Health and Nutrition Examination Survey 2003 through 2006, which used stratified, multistage, probability sampling methods to assemble a nationwide probability sample of the noninstitutionalized population of the United States. Metabolic abnormalities including BP, potassium, hemoglobin, bicarbonate, uric acid, calcium, phosphorus, and parathyroid hormone were defined by fifth or 95th percentile values.
  
  
  RESULTS
  Among participants with eGFR <60 ml/min per 1.73 m(2), black individuals were more likely than white individuals to have low hemoglobin (adjusted odds ratio [aOR] 3.76; 95% confidence interval [CI] 1.94 to 7.28), elevated uric acid (aOR 2.15; 95% CI 1.26 to 3.68), and elevated parathyroid hormone (aOR 3.93; 95% CI 2.33 to 6.66).
  
  
  CONCLUSIONS
  Metabolic consequences of reduced eGFR are more common in black individuals and seem to be present at levels well above 60 ml/min per 1.73 m(2); thus, black individuals should be screened for the metabolic complications of chronic kidney at higher GFR levels.
authors.affiliation: Department of Medicine, University of Minnesota, USA.
authors.forename: Hassan N
authors.initials: HN
authors.lastname: Ibrahim
authors.forename: Changchun
authors.initials: C
authors.lastname: Wang
authors.forename: Areef
authors.initials: A
authors.lastname: Ishani
authors.forename: Allan J
authors.initials: AJ
authors.lastname: Collins
authors.forename: Robert N
authors.initials: RN
authors.lastname: Foley
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D015415:Biomarkers / Q000097:blood; D002908:Chronic Disease; D003404:Creatinine / Q000097:blood; D003430:Cross-Sectional Studies; D005919:Glomerular Filtration Rate; D006306:Health Surveys; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007674:Kidney Diseases / Q000150:complications / Q000175:diagnosis* / Q000208:ethnology / Q000378:metabolism / Q000503:physiopathology; D008403:Mass Screening / Q000379:methods*; D008954:Models, Biological; D016017:Odds Ratio; D011237:Predictive Value of Tests; D018570:Risk Assessment; D014481:United States; D044465:White People / Q000706:statistics & numerical data
chemical_list: D015415:Biomarkers; D003404:Creatinine
references.citation: Am J Clin Nutr. 1994 Jul;60(1):117-21
references.pmid: 8017324
references.citation: J Am Geriatr Soc. 1993 Jun;41(6):612-6
references.pmid: 8505457
references.citation: Clin Endocrinol (Oxf). 2006 May;64(5):523-9
references.pmid: 16649971
references.citation: Am J Kidney Dis. 2002 May;39(5):920-9
references.pmid: 11979335
references.citation: N Engl J Med. 2006 Jun 8;354(23):2473-83
references.pmid: 16760447
references.citation: J Clin Endocrinol Metab. 1995 Oct;80(10):3068-72
references.pmid: 7559898
references.citation: Ann Intern Med. 2003 Jul 15;139(2):137-47
references.pmid: 12859163
references.citation: Am J Med. 2006 Apr;119(4):327-34
references.pmid: 16564775
references.citation: J Clin Endocrinol Metab. 1996 Mar;81(3):1108-17
references.pmid: 8772584
references.citation: J Am Soc Nephrol. 2006 Oct;17(10):2892-9
references.pmid: 16959827
references.citation: J Pediatr. 1973 May;82(5):850-1
references.pmid: 4698960
references.citation: Kidney Int. 2004 Sep;66(3):1076-81
references.pmid: 15327401
references.citation: S Afr Med J. 1975 Jun 7;49(24):965-6
references.pmid: 1154141
references.citation: J Bone Miner Res. 1994 Aug;9(8):1267-76
references.pmid: 7976509
references.citation: J Nutr. 1992 Jul;122(7):1417-24
references.pmid: 1619469
references.citation: J Clin Invest. 1985 Jun;75(6):1813-20
references.pmid: 2989333
references.citation: Circulation. 1979 Sep;60(3):697-706
references.pmid: 455628
references.citation: J Clin Invest. 1985 Aug;76(2):470-3
references.pmid: 3839801
references.citation: Am J Clin Nutr. 1983 Apr;37(4):583-94
references.pmid: 6837493
references.citation: Arch Pathol Lab Med. 1983 Apr;107(4):167-72
references.pmid: 6687536
references.citation: J Am Soc Nephrol. 2006 Jun;17(6):1710-5
references.pmid: 16641151
references.citation: J Am Soc Nephrol. 2007 Feb;18(2):654-9
references.pmid: 17215441
references.citation: Miner Electrolyte Metab. 1999 May-Jun;25(3):178-84
references.pmid: 10436403
references.citation: J Pediatr. 1997 Jul;131(1 Pt 1):87-94
references.pmid: 9255197
references.citation: Calcif Tissue Int. 1996 Dec;59(6):415-23
references.pmid: 8939764
references.citation: Am J Epidemiol. 1991 Dec 15;134(12):1410-6
references.pmid: 1776615
references.citation: J Clin Endocrinol Metab. 2000 Nov;85(11):4125-30
references.pmid: 11095443
references.citation: J Am Soc Nephrol. 2002 Nov;13(11):2762-9
references.pmid: 12397047
references.citation: Kidney Int. 2003 Aug;64(2):737-42
references.pmid: 12846773
references.citation: Am J Kidney Dis. 1998 Jan;31(1):19-27
references.pmid: 9428447
references.citation: Arch Intern Med. 2007 Jun 11;167(11):1159-65
references.pmid: 17563024
references.citation: J Am Soc Nephrol. 2007 Sep;18(9):2575-82
references.pmid: 17656476
references.citation: J Am Soc Nephrol. 2008 Jul;19(7):1396-402
references.pmid: 18579642
references.citation: Nephron Clin Pract. 2007;105(4):c178-84
references.pmid: 17347576
references.citation: J Am Soc Nephrol. 2004 Dec;15(12):3175-83
references.pmid: 15579521
references.citation: J Lab Clin Med. 1979 Apr;93(4):535-48
references.pmid: 429858
references.citation: J Am Soc Nephrol. 2008 Jul;19(7):1403-10
references.pmid: 18385428
references.citation: Kidney Int. 2007 Jan;71(1):31-8
references.pmid: 17091124