Albuminuria and renal insufficiency prevalence guides population screening: Results from the NHANES III

Albuminuria and renal insufficiency prevalence guides population screening: Results from the NHANES III . Background A number of screening criteria, applied either at a single point in time or serially, can be used for the purpose of identifying individuals at risk of end-stage renal disease (ESRD). This study focused on two such criteria measured on a single occasion, proteinuria and renal insufficiency, and examined their prevalence in a sample representative of the adult U.S. non-institutionalized population. Such knowledge guides the utility of population screening to prevent ESRD. Methods The prevalence of albuminuria (microalbuminuria and macroalbuminuria from a random urine albumin-to-creatinine ratio) and renal insufficiency [glomerular filtration rate (GFR) estimated from serum creatinine] was determined in different age categories in various adult screening groups in the cross-sectional Third National Health and Nutrition Examination Survey (NHANES III). Results A total of 14,622 adult participants were included in the analysis. In the general population, 8.3% and 1.0% of participants demonstrated microalbuminuria and macroalbuminuria, respectively. To identify one case of albuminuria, one would need to screen three persons with diabetes mellitus, seven non-diabetic hypertensive persons, or six persons over the age of 60. When albuminuria and renal insufficiency were considered together, it was clear that these tests were identifying different segments of the population; 37% of participants with a GFR less than 30 mL/min/1.73m 2 demonstrated no albuminuria. Non-albuminuric renal insufficiency was most evident in the ages of 60 to 79; 34% of diabetics, and 63% of non-diabetic hypertensives with a GFR less than 30 mL/min/1.73m 2 demonstrated no albuminuria. Conclusions Albuminuria is prevalent, and when considered together, screening tests of albuminuria and renal insufficiency measured on a single occasion identify different segments of the population. The prevalence of albuminuria and renal insufficiency in populations of interest should be considered, as this knowledge has implications for the effectiveness of screening.

[1]  C. Schmid,et al.  Effect of angiotensin-converting enzyme inhibitors on progression of nondiabetic renal disease. , 2002, Annals of internal medicine.

[2]  A. Garg,et al.  Association between renal insufficiency and malnutrition in older adults: results from the NHANES III. , 2001, Kidney international.

[3]  R. Hamm,et al.  Screening for microalbuminuria to prevent nephropathy in patients with diabetes: a systematic review of the evidence. , 2001, The Journal of family practice.

[4]  A. Nissenson,et al.  Opportunities for improving the care of patients with chronic renal insufficiency: current practice patterns. , 2001, Journal of the American Society of Nephrology : JASN.

[5]  S. Yusuf,et al.  Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and nondiabetic individuals. , 2001, JAMA.

[6]  C. Schmid,et al.  Angiotensin-Converting Enzyme Inhibitors and Progression of Nondiabetic Renal Disease , 2001, Annals of Internal Medicine.

[7]  N. Baxter Preventive health care, 2001 update: should women be routinely taught breast self-examination to screen for breast cancer? , 2001, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[8]  J. Coresh,et al.  Prevalence of high blood pressure and elevated serum creatinine level in the United States: findings from the third National Health and Nutrition Examination Survey (1988-1994). , 2001, Archives of internal medicine.

[9]  T. Valle,et al.  Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. , 2001, The New England journal of medicine.

[10]  S. Yusuf,et al.  Renal Insufficiency as a Predictor of Cardiovascular Outcomes and the Impact of Ramipril: The HOPE Randomized Trial , 2001, Annals of Internal Medicine.

[11]  Mainous Ag rd,et al.  The lack of screening for diabetic nephropathy: evidence from a privately insured population. , 2001, Family medicine.

[12]  A. Kshirsagar,et al.  Effect of ACE inhibitors in diabetic and nondiabetic chronic renal disease: a systematic overview of randomized placebo-controlled trials. , 2000, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[13]  D. Churchill,et al.  To pay or not to pay? A decision and cost-utility analysis of angiotensin-converting-enzyme inhibitor therapy for diabetic nephropathy. , 2000, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[14]  Lawrence A Leiter,et al.  Clinical problem solving based on the 1999 Canadian recommendations for the management of hypertension. , 1999, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[15]  G H Guyatt,et al.  Users' guides to the medical literature: XVII. How to use guidelines and recommendations about screening. Evidence-Based Medicine Working Group. , 1999, JAMA.

[16]  M. Labeeuw,et al.  Screening early renal failure: cut-off values for serum creatinine as an indicator of renal impairment. , 1999, Kidney international.

[17]  G. Eknoyan,et al.  Proteinuria, albuminuria, risk, assessment, detection, elimination (PARADE): a position paper of the National Kidney Foundation. , 1999, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[18]  R. Glynn,et al.  The Renal Effects of Nonsteroidal Anti‐inflammatory Drugs in Older People: Findings from the Established Populations for Epidemiologic Studies of the Elderly , 1999, Journal of the American Geriatrics Society.

[19]  A. Levey,et al.  A More Accurate Method To Estimate Glomerular Filtration Rate from Serum Creatinine: A New Prediction Equation , 1999, Annals of Internal Medicine.

[20]  J. Coresh,et al.  Serum creatinine levels in the US population: third National Health and Nutrition Examination Survey. , 1998, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[21]  C. Rembold Number needed to screen: development of a statistic for disease screening , 1998, BMJ.

[22]  G. Remuzzi,et al.  Urinary protein excretion rate is the best independent predictor of ESRF in non-diabetic proteinuric chronic nephropathies. "Gruppo Italiano di Studi Epidemiologici in Nefrologia" (GISEN). , 1998, Kidney international.

[23]  P. Whelton,et al.  Risk of end-stage renal disease in diabetes mellitus: a prospective cohort study of men screened for MRFIT. Multiple Risk Factor Intervention Trial. , 1997, JAMA.

[24]  P. Whelton,et al.  Risk of End-stage Renal Disease in Diabetes Mellitus: A Prospective Cohort Study of Men Screened for MRFIT , 1997 .

[25]  B. Freedman,et al.  Family history of end-stage renal disease among incident dialysis patients. , 1997, Journal of the American Society of Nephrology : JASN.

[26]  A. Levey,et al.  Effect of angiotensin-converting enzyme inhibitors on the progression of nondiabetic renal disease: a meta-analysis of randomized trials. Angiotensin-Converting-Enzyme Inhibition and Progressive Renal Disease Study Group. , 1997, Annals of internal medicine.

[27]  P. Whelton,et al.  End-stage renal disease in African-American and white men. 16-year MRFIT findings. , 1997, JAMA.

[28]  J. Gross,et al.  The Receiver Operating Characteristics Curve in the Evaluation of a Random Urine Specimen as a Screening Test for Diabetic Nephropathy , 1997, Diabetes Care.

[29]  K. Iseki,et al.  Risk factors of end-stage renal disease and serum creatinine in a community-based mass screening. , 1997, Kidney international.

[30]  G. Gearin,et al.  Effect of duration of type I diabetes on the prevalence of stages of diabetic nephropathy defined by urinary albumin/creatinine ratio. , 1996, Journal of the American Society of Nephrology : JASN.

[31]  M. Cline Book Review Blood: Principles and practice of hematology Edited by Robert I. Handin, Samuel E. Lux, and Thomas P. Stossel. 2304 pp., illustrated. Philadelphia, Lippincott–Raven, 1995. $169.95. 0-397-50944-8 , 1996 .

[32]  K. Yamagata,et al.  A long-term follow-up study of asymptomatic hematuria and/or proteinuria in adults. , 1996, Clinical nephrology.

[33]  Ping Wang,et al.  The Effect of Dietary Protein Restriction on the Progression of Diabetic and Nondiabetic Renal Diseases , 1996, Annals of Internal Medicine.

[34]  D. Marcelli,et al.  Proteinuria and blood pressure as causal components of progression to end-stage renal failure. Northern Italian Cooperative Study Group. , 1996, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[35]  P. Whelton,et al.  Blood pressure and end-stage renal disease in men. , 1996, The New England journal of medicine.

[36]  B. Kiberd,et al.  Screening to prevent renal failure in insulin dependent diabetic patients: an economic evaluation , 1995, BMJ.

[37]  T. Greene,et al.  Blood Pressure Control, Proteinuria, and the Progression of Renal Disease , 1995, Annals of Internal Medicine.

[38]  T. Louis,et al.  Long-term effects of antihypertensive agents on proteinuria and renal function. , 1995, Archives of internal medicine.

[39]  T V Perneger,et al.  Risk of kidney failure associated with the use of acetaminophen, aspirin, and nonsteroidal antiinflammatory drugs. , 1994, The New England journal of medicine.

[40]  B. Fielding,et al.  Urinary albumin excretion in school children. , 1984, Archives of disease in childhood.

[41]  R B Haynes,et al.  Increased absenteeism from work after detection and labeling of hypertensive patients. , 1978, The New England journal of medicine.

[42]  B. Bode,et al.  Efficacy, safety, and pump compatibility of insulin aspart used in continuous subcutaneous insulin infusion therapy in patients with type 1 diabetes. , 2001, Diabetes care.

[43]  P. Mueller,et al.  Urinary albumin excretion in children: factors related to elevated excretion in the United States population. , 1999, Renal failure.

[44]  Detection The sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) , 1997 .

[45]  B. Kasiske,et al.  Screening and management of microalbuminuria in patients with diabetes mellitus: recommendations to the Scientific Advisory Board of the National Kidney Foundation from an ad hoc committee of the Council on Diabetes Mellitus of the National Kidney Foundation. , 1995, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[46]  Cockcroft Dw,et al.  Prediction of Creatinine Clearance from Serum Creatinine , 1976 .

[47]  F. Ruddle,et al.  Report of the committee on the genetic constitution of autosomes other than chromosomes 1,2 and 6. , 1976, Birth defects original article series.