title: Occult chronic kidney disease among persons with hypertension in the United States: data from the National Health and Nutrition Surveys 1988-1994 and 1999-2002.
abstract: OBJECTIVE
  Hypertension guidelines recommend screening for chronic kidney disease (CKD) using serum creatinine and urine dipstick; this strategy may lead to misclassification. Persons with occult CKD [i.e. missed by creatinine but detected by cystatin C or albumin-to-creatinine ratio (ACR)] have higher risks for death, cardiovascular events, and end-stage renal disease.
  
  
  METHODS
  We studied occult CKD prevalence among nondiabetic, hypertensive adults in National Health and Nutrition Examination Survey 1988-1994 (N = 2088) and 1999-2002 (N = 737). We defined occult CKD as estimated glomerular filtration rate by cystatin C (eGFRcys) less than 60 ml/min per 1.73 m and/or ACR at least 30 mg/g among persons with eGFRcreat more than 60 ml/min per 1.73 m. We studied occult CKD prevalence by either marker, stratified by age, race/ethnicity, and assessed clinical predictors associated with occult CKD presence.
  
  
  RESULTS
  In 1988-1994, occult CKD was prevalent among 25% of nondiabetic hypertensive persons, and it was 22% in 1999-2002. Each marker's ability to detect occult CKD varied by age and race. Cystatin C detected occult CKD among 8.9% of persons more than 65 years, and among 3.8% of whites. ACR detected occult CKD among 9.3% of persons less than 45 years, 16.6% of Blacks, and 20.6% of Mexican-Americans. In multivariate models, each decade of advancing age was associated with a higher occult CKD prevalence by cystatin C (OR 3.1, 95% CI 2.5-3.8) in 1988-1994 and 1999-2002 (OR 2.9, 1.8-4.6).
  
  
  CONCLUSIONS
  Current hypertension guidelines may fail to detect a large proportion of high-risk individuals with CKD who can be identified by cystatin C or ACR. Future studies are needed to evaluate targeted use of multimarker renal panels among hypertensives.
authors: University of California, San Francisco, California, USA. carmenalicia.peralta@ucsf.edu
authors: Carmen A
authors: CA
authors: Peralta
authors: Cristin C
authors: CC
authors: Weekley
authors: Yongmei
authors: Y
authors: Li
authors: Michael G
authors: MG
authors: Shlipak
mesh_terms: D000368:Aged; D058070:Asymptomatic Diseases / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology
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