Early detection of kidney disease in community settings: The Kidney Early Evaluation Program (KEEP)
Early detection of kidney disease in community settings: The Kidney Early Evaluation Program (KEEP)
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DOI：
10.1016/s0272-6386(03)00405-0
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发表时间：
2003-07-01
影响因子：
13.2
通讯作者：
Flack, JM
中科院分区：
文献类型：
--
作者：
Brown, WW;Peters, RM;Flack, JM
背景资料。及早识别有肾病风险的人提供了防止或延缓其进展并降低发病率和死亡率的机会。我们的假设是，在具有高危人群的社区实施有针对性的筛查计划，将检测到以前未被确认患有或处于慢性肾脏疾病(CKD)高危人群的人，他们的患病率超过了普通人群中对CKD的预测。方法：对高血压或糖尿病患者或有高血压、糖尿病或肾脏疾病的一级亲属进行肾脏疾病危险因素的筛查。观察血压、血糖、血肌酐、血红蛋白、微量白蛋白尿、血尿、脓尿、体重指数和估计的肾小球滤过率(EGFR)。结果：从2000年8月至2001年12月共筛选出6,071名符合条件的人：其中68%为女性，43%为非裔美国人，36%为白人，10%为西班牙裔，5%为土著美国人。大多数人报告高中或以上学历(84%)和医疗保险覆盖面(86%)。27%的人符合糖尿病的筛查定义；的筛查定义为高血压；29%的人符合微量蛋白尿；8%的人符合贫血；18%的人符合血尿；13%的人符合脓尿；5%的人符合血清肌酐水平升高；16%的人符合表皮生长因子受体降低的定义；44%的人符合肥胖的定义。在没有报告特定病史的参与者中，筛查发现82名参与者(2%)患有糖尿病，1014名参与者(35%)。有高血压的277名参与者(5%)血清肌酐水平升高，839名参与者(14%)EGFR降低，1712名参与者(29%)微量白蛋白尿。有糖尿病病史的参与者中有35%的人在筛查时血糖水平升高(大于或等于180 mg/dL[10 mmoL/L])，有高血压病史的%的人血压没有控制在146/90毫米汞柱以下。只有16%的有糖尿病病史的参与者和EGFR降低的男性患者的血压分别控制在130/80毫米汞和135/85毫米汞以下。结论：靶向筛查可以有效地识别出先前未被识别或控制不佳的肾脏疾病危险因素的患者，以及EGFR中度降低的患者。
Background. Early identification of persons at risk for kidney disease provides an opportunity to prevent or delay its progression and decrease morbidity and mortality. Our hypothesis was that implementation of a targeted screening program in communities with high-risk populations Would detect previously unidentified persons with or at high risk for chronic kidney disease (CKD) with a prevalence that exceeds that predicted for CKD in the general population. Methods: Persons with hypertension or diabetes or a first-order relative with hypertension, diabetes, or kidney disease were screened for kidney disease risk factors. Blood pressure, blood glucose level serum creatinine level, hemoglobin level, microalbuminuria, hematuria, pyuria, body mass index, and estimated glomerum lar filtration rate (EGFR) Were evaluated. Results: Six thousand seventy-one eligible persons were screened from August 2000 through December 2001: of these persons, 68% were women, 43% were African American, 36% Were white, 10% were Hispanic, and 5% were Native American. Most reported high-school education or more (84%) and health insurance coverage (86%). Twenty-seven percent met the screening definitions for diabetes; 64%, for hypertension; 29%, for microalbuminuria 8%, for anemia; 18%, for hematuria;13%, for pyuria; 5%, for elevated serum creatinine level; 16% for reduced EGFR; and 44%, for obesity. Among participants Without a reported history of specified conditions, screening identified 82 participants (2%) With diabetes, 1,014 participants (35%). With hypertension, 277 participants (5%) with elevated serum creatinine levels, 839 participants (14%) with reduced EGFRs, and 1,712 partcipants (29%) with microalbuminuria. Thirty-five percent of participants with a history, of diabetes had elevated serum glucose levels at screening (greater than or equal to180 mg/dL [10 mmol/L]), and 64% with a history of hypertension did not hive blood pressure controlled to less than 146/90 mm Hg. Only 16% of participants with a history of diabetes and M with a reduced EGFR had blood pressure controlled to less than 130/80 mm Hg and less than 135/85 mm Hg, respectively. Conclusion: Targeted screening is effective in identifying persons with previously unidentified or poorly controlled kidney disease risk factors, as well as persons with a moderately decreased EGFR.