Diabetes mellitus and CKD awareness: the Kidney Early Evaluation Program (KEEP) and National Health and Nutrition Examination Survey (NHANES).
BACKGROUND
Diabetes contributes to increased morbidity and mortality in patients with chronic kidney disease (CKD). We sought to describe CKD awareness and identify factors associated with optimal glycemic control in diabetic and nondiabetic individuals both aware and unaware of CKD.


METHODS
This cross-sectional analysis compared Kidney Early Evaluation Program (KEEP) and National Health and Nutrition and Examination Survey (NHANES) 1999 to 2006 participants with diabetes and CKD. CKD was defined and staged using glomerular filtration rate (estimated by using the 4-variable Modification of Diet in Renal Disease Study equation) and urine albumin-creatinine ratio. NHANES defined diabetes as self-reported diabetes or fasting plasma blood glucose level of 126 mg/dL or greater, and KEEP as self-reported diabetes or diabetic retinopathy, use of diabetes medications, fasting blood glucose level of 126 mg/dL or greater, or nonfasting glucose level of 200 mg/dL or greater.


RESULTS
Of 77,077 KEEP participants, 20,200 (26.2%) were identified with CKD and 23,082 (29.9%) were identified with diabetes. Of 9,536 NHANES participants, 1,743 (18.3%) were identified with CKD and 1,127 (11.8%) were identified with diabetes. Of KEEP participants with diabetes and CKD (n = 7,853), 736 (9.4%) were aware of CKD. Trends in lack of CKD awareness were similar for KEEP participants with and without diabetes. Unaware participants with and without diabetes identified with stages 1 and 2 CKD were less likely to reach target glucose levels, defined as fasting glucose level less than 126 mg/dL or nonfasting glucose level less than 140 mg/dL, than those with stages 3 to 5 (odds ratio, 0.69; 95% confidence interval, 0.62 to 0.78; odds ratio, 0.69; 95% confidence interval, 0.58 to 0.81; P < 0.001, respectively).


CONCLUSIONS
Our data support that KEEP, as a targeted screening program, is a more enriched population with CKD and comorbid diabetes than NHANES. In addition, our findings highlight the relationship between dysglycemia and early stages of unidentified CKD.
Whaley-Connell
Adam
A
Department of Internal Medicine, University of Missouri-Columbia School of Medicine and Harry S. Truman VA Medical Center, Columbia, MO 65212, USA. whaleyconnella@health.missouri.edu
Sowers
James R
JR
McCullough
Peter A
PA
Roberts
Tricia
T
McFarlane
Samy I
SI
Chen
Shu-Cheng
SC
Li
Suying
S
Wang
Changchun
C
Collins
Allan J
AJ
Bakris
George L
GL
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001364:Awareness; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure / Q000502:physiology; D015992:Body Mass Index; D002784:Cholesterol / Q000097:blood; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003928:Diabetic Nephropathies / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D042241:Early Diagnosis; D005919:Glomerular Filtration Rate / Q000502:physiology; D006306:Health Surveys; D006801:Humans; D006937:Hypercholesterolemia / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D008403:Mass Screening / Q000706:statistics & numerical data*; D024821:Metabolic Syndrome / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology; D008875:Middle Aged; D009765:Obesity / Q000097:blood / Q000453:epidemiology; D012307:Risk Factors; D012737:Sex Factors; D014280:Triglycerides / Q000097:blood; D014481:United States; D055815:Young Adult
D001786:Blood Glucose; D014280:Triglycerides; D002784:Cholesterol