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• W2046135156 abstract "The International Kidney Evaluation Association Japan evaluated chronic kidney disease (CKD) in Japan, using a Japanese version of the US National Kidney Foundation's Kidney Early Evaluation Program (KEEP). The screening criteria for the first 1065 participants were presence of diabetes or hypertension, or family history of diabetes, hypertension, or kidney disease. Mean age was 59.7±16.1 years; 501 participants were men, 564 women. Of participants, 26.9% had diabetes, 59.2% had hypertension (with an additional 21.5% diagnosed after the program), 16.9% had history of diabetes and hypertension together, and 30.6% had neither, but had family history of diabetes, hypertension, or kidney disease. CKD (stages 1–4) prevalence was 26.7%, defined by albumin–creatinine ratio and estimated glomerular filtration rate. CKD prevalence was 35.0% among diabetic participants, 34.8% among hypertensive participants, and 37.1% among participants with cardiovascular disease (CVD). The following baseline conditions were significantly associated with discovered CKD: diabetes, odds ratio 1.71 (95% confidence interval 1.28–2.30); hypertension, 3.42 (2.15–5.44); CVD, 1.88 (1.37–2.57). CKD prevalence was high compared with the general Japanese population. KEEP Japan seems to define a high-risk population with evidence of CKD based on the targeted nature of the program. The International Kidney Evaluation Association Japan evaluated chronic kidney disease (CKD) in Japan, using a Japanese version of the US National Kidney Foundation's Kidney Early Evaluation Program (KEEP). The screening criteria for the first 1065 participants were presence of diabetes or hypertension, or family history of diabetes, hypertension, or kidney disease. Mean age was 59.7±16.1 years; 501 participants were men, 564 women. Of participants, 26.9% had diabetes, 59.2% had hypertension (with an additional 21.5% diagnosed after the program), 16.9% had history of diabetes and hypertension together, and 30.6% had neither, but had family history of diabetes, hypertension, or kidney disease. CKD (stages 1–4) prevalence was 26.7%, defined by albumin–creatinine ratio and estimated glomerular filtration rate. CKD prevalence was 35.0% among diabetic participants, 34.8% among hypertensive participants, and 37.1% among participants with cardiovascular disease (CVD). The following baseline conditions were significantly associated with discovered CKD: diabetes, odds ratio 1.71 (95% confidence interval 1.28–2.30); hypertension, 3.42 (2.15–5.44); CVD, 1.88 (1.37–2.57). CKD prevalence was high compared with the general Japanese population. KEEP Japan seems to define a high-risk population with evidence of CKD based on the targeted nature of the program. The rising incidence and prevalence of renal failure, the high cost of its treatment, and its adverse outcomes are major public health problems worldwide.1.Levey A.S. Eckardt K.U. Tsukamoto Y. et al.Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO).Kidney Int. 2005; 67: 2089-2100Abstract Full Text Full Text PDF PubMed Scopus (2510) Google Scholar In 2002, the US National Kidney Foundation (NKF) announced a new, comprehensive chronic kidney disease (CKD)2.National Kidney FoundationK/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Kidney Disease Outcome Quality Initiative.Am J Kidney Dis. 2002; 39: S1-S266PubMed Google Scholar classification system defined by an elevated urinary albumin level and reduced kidney function that may require dialysis or kidney transplant for survival. The number of CKD patients whose disease progresses to end-stage renal disease (ESRD) and who start dialysis is increasing from year to year. In Japan, there were 275,119 dialysis patients as of December 2007.3.An overview of regular dialysis treatment in Japan as of December 31, 2007. Japanese Society for Dialysis Therapy. Available at www.jsdt.or.jp. Accessed 20 October 2009.Google Scholar Not only may CKD progress to ESRD but it is also a risk factor for cardiovascular disease (CVD),4.Mann J.F. Gerstein H.C. Pogue J. et al.Renal insufficiency as a predictor of cardiovascular outcomes and the impact of ramipril: the HOPE randomized trial.Ann Intern Med. 2001; 134: 629-636Crossref PubMed Scopus (1250) Google Scholar including heart attack and stroke, and for death.5.Go A.S. Chertow G.M. Fan D. et al.Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization.N Engl J Med. 2004; 351: 1296-1305Crossref PubMed Scopus (8983) Google Scholar Current medications can effectively treat CKD,6.Levey A.S. Andreoli S.P. DuBose T. et al.CKD: common, harmful, and treatable – World Kidney Day 2007.Am J Kidney Dis. 2007; 49: 175-179Abstract Full Text Full Text PDF PubMed Scopus (47) Google Scholar especially when intervention is started early. The rationale for identifying the CKD population is also driven by its high costs. The dialysis population has increased to such an extent that it accounts for 4–5% of Japan's national medical expenditures.7.Ministry of Health, Labour, and Welfare. Available at http://www.mhlw.go.jp. Accessed 20 October 2009.Google Scholar Renal failure is the eighth largest cause of mortality,8.Ministry of Health, Labour, and Welfare. Available at http://www.mhlw.go.jp/toukei/saikin/. Accessed 20 October 2009.Google Scholar and, along with the high cost of ESRD treatment, makes kidney disease a major public health problem that needs to be addressed with early detection and treatment. School-based, occupational health, and community health screening systems have been established in Japan,9.Tokyo Health Service Association Activity Report 2007. Available at http://www.yobouigaku-tokyo.or.jp/gaiyo/. Accessed 20 October 2009.Google Scholar but attendance rates for examinations are less than ideal and follow-up is insufficient. Public awareness of CKD seems to be low compared with other major diseases such as stroke, hypertension, and CVD. The International Kidney Evaluation Association Japan (IKEAJ) was created in June 2006 to improve CKD awareness by performing screenings in Japan, and to help combat CKD in Japan while adding to the emerging international data on screening of high-risk populations. IKEAJ, in collaboration with the NKF in the United States, developed a Japanese version of the NKF Kidney Early Evaluation Program (KEEP), called KEEP Japan. This study's objective was to report data from KEEP Japan's first 2 years (June 2006 through May 2008), and to evaluate the usefulness of KEEP Japan for early detection of CKD in a targeted high-risk population with a history of diabetes, hypertension, or family history of these diseases or of kidney failure. KEEP Japan included a total of 1065 participants (aged 59.7±16.1 years), of whom 501 were men (aged 59.1±16.2 years) and 564 were women (aged 60.2±15.9 years; Table 1); more than two-thirds of NKF KEEP participants were women (aged 53.9±15.6 years; men were aged 54.5±15.7 years) as of 31 December 2007.10.National Kidney Foundation: Kidney Early Evaluation Program (KEEP) 2008 Annual Data Report.Am J Kidney Dis. 2009; 53: S1-S135Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar Overall, 26.9% of KEEP Japan participants self-reported diabetes, compared with 28.2% in NKF KEEP; 59.2% self-reported hypertension, compared with 54.6% in NKF KEEP; and 16.9% self-reported both conditions, compared with 19.7% in NKF KEEP. In KEEP Japan, 30.6% of participants, compared with 36.9% in NKF KEEP, self-reported neither diabetes nor hypertension, but reported family history of diabetes, hypertension, or kidney disease (Table 2).Table 1Distribution of KEEP Japan participants by age groupAge groups, yearsParticipants<1920–2930–3940–4950–5960–6970–79≥80Total n, 106520486910619429426866 Percent1.94.56.510.018.227.625.26.2Men n, 501122131598814012327 Percent2.44.26.211.817.627.924.65.4Women n, 564827384710615414539 Percent1.44.86.78.318.827.325.76.9 Open table in a new tab Table 2KEEP Japan participant characteristicsChronic kidney disease stageaClassified by US National Kidney Foundation Kidney Early Evaluation Program Stages, defined by estimated glomerular filtration rate (ml/min per 1.73 m2) and albumin-creatinine ratio (mg/g).CharacteristicTotalStage 0bNo kidney disease.Stage 1Stage 2Stages 3–4Diabetes286 (26.9)186 (65.0)28 (9.8)48 (16.8)24 (8.4)Hypertension630 (59.2)402 (63.8)56 (8.9)109 (17.3)63 (10.0)Diabetes and hypertension180 (16.9)106 (58.9)19 (10.6)37 (20.6)18 (10.0)No diabetes or hypertension, known family history of diabetes, hypertension, or kidney disease326 (30.6)296 (90.8)11 (3.4)14 (4.3)5 (1.5)Known family history of diabetes348 (32.7)270 (77.6)20 (5.7)36 (10.3)22 (6.3)Known family history of hypertension625 (58.7)467 (74.7)42 (6.7)78 (12.5)38 (6.1)Known family history of kidney disease204 (19.2)164 (80.4)12 (5.9)18 (8.8)10 (4.9)Met basic criteriacAnswered ‘Yes’ to one of the following: ‘Have you ever been diagnosed with diabetes?’, ‘Have you ever been diagnosed with hypertension?’, ‘Does any member of your family have diabetes?’, ‘Does any member of your family have hypertension?’, or ‘Does any member of your family have kidney disease?’.1065 (100)781 (73.3)76 (7.1)134 (12.6)74 (6.9)Note: Values are n (%) unless otherwise noted.a Classified by US National Kidney Foundation Kidney Early Evaluation Program Stages, defined by estimated glomerular filtration rate (ml/min per 1.73 m2) and albumin-creatinine ratio (mg/g).b No kidney disease.c Answered ‘Yes’ to one of the following: ‘Have you ever been diagnosed with diabetes?’, ‘Have you ever been diagnosed with hypertension?’, ‘Does any member of your family have diabetes?’, ‘Does any member of your family have hypertension?’, or ‘Does any member of your family have kidney disease?’. Open table in a new tab Note: Values are n (%) unless otherwise noted. Chronic kidney disease was classified by the five stages used by NKF KEEP, on the basis of the estimated glomerular filtration rate (eGFR, ml/min per 1.73 m2) and albumin–creatinine ratio (ACR, mg/g). CKD prevalence was 26.7%, including 7.1% in stage 1, 12.6% in stage 2, 6.8% in stage 3, and 0.2% in stage 4. Proteinuria and ACR were compared by CKD stage (Table 3). Similarly, CKD prevalence in NKF KEEP was 26.2%; however, CKD stage distribution differed, with 3.0% in stage 1, 4.9% in stage 2, 17.3% in stage 3, and 1% in stage 4–5. Urine protein, determined by the dipstick method, was positive for 7.2% (9.8% of men and 5.0% of women) in KEEP Japan. ACR ≥30 mg/g was present in 23.6%, compared with 11.7% in the NKF KEEP population, with significantly lower percentages of CKD stages 1 and 2 in NKF KEEP participants. Numbers of participants with CKD identified by eGFR <60 ml/min per 1.73 m2, ACR ≥30 mg/g, and both are shown in Figure 1.Table 3Comparison of proteinuria and albumin–creatinine ratio (ACR)Chronic kidney disease stageStage 0aNo kidney disease.Stage 1Stage 2Stages 3–4Totaln78176134741065ACR ≥30 mg/g, n07613441251Proteinuria Total (n=1065)7 (9.1)17 (22.1)32 (41.6)21 (27.0)77 Men (n=501)3 (6.1)13 (26.5)18 (36.7)15 (30.6)49 Women (n=564)4 (14.3)4 (14.3)14 (50.0)6 (21.4)28Note: Values are n (%) unless otherwise noted.a No kidney disease. Open table in a new tab Note: Values are n (%) unless otherwise noted. According to the traditional criteria for CKD diagnosis (serum creatinine (SCr) >1.5 mg/dl for men and >1.3 mg/dl for women), SCr was abnormally high for 101 (9.5%) KEEP Japan participants, compared with 5.7% in NKF KEEP. Of these, 84 (7.9% of the population vs 5.62% in NKF KEEP) fit the CKD diagnostic category of stage 1 or higher, and 74 (6.9% of the population vs 5.62% in NKF KEEP) stage 3 or higher. In KEEP Japan, of the 286 (26.8 vs 32.3% in NKF KEEP) participants with diagnosed or self-reported diabetes, 129 (45.1 vs 57.0% in NKF KEEP) were treated with hypoglycemic agents and 42 (14.7 vs 18.0% in NKF KEEP) with insulin. Glycemic control was inadequate (nonfasting blood glucose >139 mg/dl, by NKF criteria) for 35.0% (vs 44.9% in NKF KEEP) of diabetic participants, including 41.1% (72.7% in NKF KEEP) of those using hypoglycemic agents and 61.9% (29.3% in NKF KEEP) of those using insulin (Figure 2a). Corresponding percentages based on HbA1c values were 35.0, 50.0, and 60.0% (Figure 2b). Numbers of participants with CKD and diabetes, hypertension, and CVD are reported in Tables 4, 5 and 6 by CKD stage. CKD prevalence in diabetic participants was 35.0%, comparable to NKF KEEP findings of 35.2%, and the relative risk of CKD comparing diabetic and nondiabetic participants was 1.46. The odds ratio for CKD occurrence in diabetic compared with nondiabetic participants was 1.71 (95% confidence interval (CI) 1.28–2.30; P<0.0001) vs 1.95 (95% CI 1.88–2.01; P<0.0001) in NKF KEEP. Blood glucose >139 mg/dl was newly found in 21 participants, of whom three had stage 2 CKD and two had stage 3 CKD.Table 4Numbers of participants with diabetes and chronic kidney diseaseDiabetesChronic kidney diseaseYesNoTotalTotal2867791065Stage 0aNo kidney disease.186 (23.8)595 (76.2)781Stage 128 (36.8)48 (63.2)76Stage 248 (35.8)86 (64.2)134Stages 3–424 (32.4)50 (67.5)74Chronic kidney diseaseDiabetesYes, stages 1–4No, stage 0TotalYes100 (35.0)186 (65.0)286No186 (23.9)593 (76.1)779Note: Values are n (%) unless otherwise noted.a No kidney disease. Open table in a new tab Table 5Numbers of participants with hypertension and chronic kidney diseaseHypertension (JNC7)Chronic kidney diseaseNormal blood pressurePrehypertensionStage 1Stage 2TotalTotal185 (17.4)432 (41.0)326 (31.0)122 (11.5)1065Stage 0aNo kidney disease.160 (20.4)329 (42.1)225 (28.8)67 (8.6)781Stage 16 (7.9)25 (32.9)31 (41.0)14 (18.4)76Stage 213 (9.7)48 (35.8)45 (33.6)28 (21.0)134Stages 3–46 (8.1)30 (40.5)25 (33.8)13 (17.6)74Chronic kidney diseaseHypertensionbExcludes prehypertension.Yes, stages 1–4No, stage 0TotalYes, stages 1–2156 (34.8)292 (65.2)448No25 (13.5)160 (86.5)185Note: Values are n (%) unless otherwise noted.a No kidney disease.b Excludes prehypertension. Open table in a new tab Table 6Participants with cardiovascular disease and chronic kidney diseaseCardiovascular diseaseaDefined as self-reported heart attack, coronary bypass surgery, cardiovascular angioplasty, heart failure, prosthetic valve dysfunction, or arrhythmia.Chronic kidney disease stagesYesNoTotalTotal221 (20.8)844 (79.2)1065Stage 0bNo kidney disease.139 (17.8)642 (82.2)781Stage 120 (26.3)56 (73.7)76Stage 236 (26.9)98 (73.1)134Stages 1–482 (28.9)202 (71.1)284Stages 3–4 Yes26 (35.1)48 (64.9)74 No195 (19.7)796 (80.3)991Note: Values are n (%) unless otherwise indicated.a Defined as self-reported heart attack, coronary bypass surgery, cardiovascular angioplasty, heart failure, prosthetic valve dysfunction, or arrhythmia.b No kidney disease. Open table in a new tab Note: Values are n (%) unless otherwise noted. Note: Values are n (%) unless otherwise noted. Note: Values are n (%) unless otherwise indicated. Of the 630 (59.2 vs 54.6% in NKF KEEP) participants with self-reported hypertension, 356 were at stage 1 or 2 according to criteria from the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7);11.Chobanian A.V. Bakris G.L. Black H.R. et al.The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report.JAMA. 2003; 289: 2560-2572Crossref PubMed Scopus (16537) Google Scholar 92 were newly included in this category after participating in screening. Of participants with self-reported hypertension, 586 (93.0% vs 79.8 in NKF KEEP) were using antihypertensive agents. Of them, 228 (38.9 vs 35.3% in NKF KEEP) were at stage 1 hypertension and 82 (14.0 vs 19.5% in NKF KEEP) were at stage 2. CKD prevalence in hypertensive participants (excluding prehypertension determined according to JNC-7 criteria) was 34.8% (vs 35.7% in NKF KEEP), and the relative risk of CKD comparing participants with hypertension and normal blood pressure was 2.58. The odds ratio for CKD occurrence in participants with hypertension compared with normal blood pressure was 3.42 (95% CI 2.15–5.44; P<0.001) vs 1.91 (95% CI 1.82–2.00; P<0.001) for NKF KEEP. Among all participants, 221 (20.8 vs 21.2% in NKF KEEP) self-reported one or more CVD-related conditions (heart attack, coronary bypass surgery, cardiovascular angioplasty, heart failure, prosthetic valve dysfunction, or arrhythmia) before screening. CVD was present in 28.3% (vs 31.8% in NKF KEEP) of participants with self-reported diabetes, in 29.0% (vs 28.2% in NKF KEEP) of participants with self-reported hypertension, and in 38.3% (36.4% in NKF KEEP) of participants with both. CKD prevalence in participants with CVD was 37.1% (vs 31.0% in NKF KEEP), and the relative risk of CVD comparing CKD and non-CKD participants was 1.62. The odds ratio for CVD occurrence in CKD compared with non-CKD participants was 1.88 (95% CI 1.37–2.57; P<0.001). This ratio was higher for participants with stage 3 CKD (2.21; 95% CI 1.34–3.65; P<0.001). Anemia was defined according to the World Health Organization and the NKF Kidney Disease Outcomes Quality Initiative definitions. Anemia prevalence in CKD stages 0–3 is shown in Figure 3; prevalence was higher in participants with CKD stage 3 regardless of sex (P<0.05). Lipid levels (high-density lipoprotein and low-density lipoprotein cholesterol) are shown for CKD stages 0–3 in Figure 4. High-density lipoprotein-cholesterol levels tended to decrease with advancing CKD in both men and women.Figure 4Cholesterol values by chronic kidney disease stage. (a) Low-density lipoprotein (LDL) cholesterol values by chronic kidney disease stage (0–3 only because of low numbers at stage 4), all. (b) High-density lipoprotein (HDL) cholesterol values by chronic kidney disease stage (0–3 only because of low numbers at stage 4), men. (c) High-density lipoprotein (HDL) cholesterol values by chronic kidney disease stage (0–3 only because of low numbers at stage 4), women.View Large Image Figure ViewerDownload Hi-res image Download (PPT) In its first 2 years, KEEP Japan screened 1065 participants with CKD risk factors (diabetes, hypertension, or family history of diabetes, hypertension, or kidney disease). Of them, 26.7% showed evidence of CKD stages 1–4, as measured by eGFR and ACR; 7.0% of participants showed evidence of CKD stages 3–4. The proteinuria rate was 7.2%, compared with 1–2% in school-based examinations, and 3–4% in occupational health examinations.12.Labour Standards Bureau, Ministry of Health, Labour, and Welfare. Available at http://www.mhlw.go.jp. Accessed 20 October 2009.Google Scholar The higher levels of proteinuria noted in KEEP Japan may be partly due to participants being selected for high CKD risk. KEEP Japan seems to identify a high-risk population with evidence of kidney disease and with inadequate control of blood pressure, findings similar to those reported in NKF KEEP in the United States.10.National Kidney Foundation: Kidney Early Evaluation Program (KEEP) 2008 Annual Data Report.Am J Kidney Dis. 2009; 53: S1-S135Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar Early CKD can be detected only by examination. Evaluation of renal function is simple if based on SCr, but results are not always accurate for people with low body mass index, elderly people, or women.13.Glassock R.J. Winearls C.G. eGFR: readjusting its rating.Clin J Am Soc Nephrol. 2009; 4: 867-869Crossref PubMed Scopus (16) Google Scholar Abnormally elevated creatinine levels were noted in only 2% of participants, compared with 27% with CKD defined by the classification system, which is more than 10-fold higher. Comparisons with US NKF KEEP data were possible through direct calibration of the SCr assay to reduce errors. Therefore, our findings are comparable to the NKF KEEP findings for this targeted, self-referred population. From a public health perspective, KEEP Japan demonstrates that CKD is underrecognized and that risk factors are inadequately controlled, potentially adding to the increasing numbers of patients who reach ESRD. KEEP Japan and NKF KEEP seem to be similar in participant characteristics, examination methods, and standards. Few KEEP Japan participants were at CKD stage 4 and none were at stage 5, findings similar to US data.10.National Kidney Foundation: Kidney Early Evaluation Program (KEEP) 2008 Annual Data Report.Am J Kidney Dis. 2009; 53: S1-S135Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar Several reasons for this can be suggested: (1) the program was in its initial years; (2) people with known kidney disease or proteinuria were excluded from the study population; and (3) Japan has a universal health insurance plan, making health care readily available. Prevalence of CVD risk factors in the Japanese population may differ from prevalence in the United States, particularly related to stroke compared with cardiac disease.14.World Health Organization Database Available at http://apps.who.int/whosis/data. Accessed 20 October 2009.Google Scholar According to the 2006 national survey of health and nutrition in Japan, diabetes is strongly suspected in 8.2 million people and cannot be ruled out in about 10.5 million, for an estimated total of 18.7 million diabetic (incipient and otherwise) people.15.Japanese Ministry of Health, Labour, and Welfare's annual survey in 2006 on the health and nutrition status of Japanese people. Available at http://www.mhlw.go.jp. Accessed 20 October 2009.Google Scholar According to KEEP Japan data, CKD prevalence in participants with self-reported diabetes was 26.9%, suggesting a high burden of CKD in this population and possibly contributing to the increasing number of diabetic patients developing ESRD in Japan.16.Nakai S. Masakane I. Akiba T. et al.Overview of regular dialysis treatment in Japan as of 31 December 2006.Ther Apher Dial. 2008; 12: 428-456Crossref PubMed Scopus (57) Google Scholar From this perspective, screening high-risk populations with diabetes and hypertension should be considered as a matter of public health policy in Japan. This report summarizes the initial findings from a self-referred population, and the findings may not be generalizable to the total Japanese population. Comparisons with random samples of the Japanese population will be needed to determine whether findings are comparable, as has been carried out with the NKF KEEP findings.17.Whaley-Connell A.T. Sowers J.R. Stevens L.A. et al.CKD in the United States: Kidney Early Evaluation Program (KEEP) and National Health and Examination Survey 1999–2004.Am J Kidney Dis. 2008; 51: S13-S20Abstract Full Text Full Text PDF PubMed Scopus (149) Google Scholar, 18.Whaley-Connell A.T. Sowers J.R. McFarlane S.I. et al.Diabetes Mellitus in CKD: Kidney Early Evaluation Program (KEEP) and National Health and Nutrition Examination Survey (NHANES) 1999 to 2004.Am J Kidney Dis. 2008; 51: S21-S29Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar, 19.Rao M.V. Qui Y. Wang C. et al.Hypertension and CKD: Kidney Early Evaluation Program (KEEP) and National Health and Nutrition Examination Survey (NHANES) 1999 to 2004.Am J Kidney Dis. 2008; 51: S30-S37Abstract Full Text Full Text PDF PubMed Scopus (117) Google Scholar, 20.McCullough P.A. Li S. Jurkovitz C.T. et al.CKD and Cardiovascular Disease in Screened High-Risk Volunteer and General Populations: Kidney Early Evaluation Program (KEEP) and National Health and Nutrition Examination Survey (NHANES) 1999 to 2004.Am J Kidney Dis. 2008; 51: S38-S45Abstract Full Text Full Text PDF PubMed Scopus (130) Google Scholar, 21.McFarlane S.I. Chen S.C. Whaley-Connell A.T. et al.Prevalence and Associations of Anemia of CKD: Kidney Early Evaluation Program (KEEP) and National Health and Nutrition Examination Survey (NHANES) 1999 to 2004.Am J Kidney Dis. 2008; 51: S46-S55Abstract Full Text Full Text PDF PubMed Scopus (81) Google Scholar, 22.Vassalotti J.A. Uribarri J. Chen S.C. et al.Trends in Mineral Metabolism: Kidney Early Evaluation Program (KEEP) and National Health and Nutrition Examination Survey (NHANES) 1999 to 2004.Am J Kidney Dis. 2008; 51: S56-S68Abstract Full Text Full Text PDF PubMed Scopus (55) Google Scholar Data on smoking were not collected using the health screening questionnaire. The equation used to estimate GFR was based on the Modification of Diet in Renal Disease (MDRD) formula, which has not been validated in Asian populations. Asian populations differ from US white and African-American populations in muscle mass and protein intake, and these differences need to be addressed. We used a modified MDRD formula;23.Levey A.S. Coresh J. Greene T. et al.Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate.Ann Intern Med. 2006; 145: 247-254Crossref PubMed Scopus (4090) Google Scholar however, a more direct equation for Japan should be developed, accounting for the underestimation of GFR >60 ml/min per 1.73 m2, as in the new CKD-EPI equation reported by Levey et al.24.Levey A.S. Stevens L.A. Schmid C.H. et al.A new equation to estimate glomerular filtration rate.Ann Intern Med. 2009; 150: 604-612Crossref PubMed Scopus (15951) Google Scholar As these new methods are developed and applied to the Japanese population, a more accurate picture of CKD should emerge. Comparison of KEEP Japan data and NKF KEEP data, however, demonstrates that CKD is a problem in Japan and that treatment is inadequate. The public health implications are unchanged despite any testing biases. Chronic kidney disease is present in a larger number of people in Japan than previously realized. The targeted high-risk KEEP Japan participants showed evidence of CKD with poorly controlled blood pressure and blood glucose. Focusing on a high-risk population seems to have a high yield for detecting early CKD and suggests that improved care is needed. Because Japan has the second-highest prevalence rates for treated ESRD in the world, behind Taiwan, our findings suggest that greater attention to CKD is needed. Long-term follow-up of the population, assessing CKD detection efforts, and treatment and control of risk factors will be needed to determine the impact of a public health awareness program such as KEEP Japan." @default.
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• W2046135156 title "The Kidney Early Evaluation Program (KEEP) of Japan: results from the initial screening period" @default.
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