Health history - CacheFlykidneyfoundation.cachefly.net/keep/adr2006/04chapter3healthhistory.pdf ·...

Chapter 3 «» Health history s29

d i a b e t e s

h y p e r t e n s i o n

c a r d i o v a s c u l a r d i s e a s e

o b e s i t y

s m o k i n g

e v i d e n c e o f k i d n e y d i s e a s e

f a m i l y h i s t o r y & c o m o r b i d i t y

i n t e r v e n t i o n

H e a l t h h i s to r y3

“My mama died from undetected kidney disease in Oct. 2002. It was only after 20 years of being treated for high blood pressure, a blood test [was done] to check on her kidneys. She went on dialysis but died a few months later. That’s why I got involved and got screened. Thank you for coming and helping us!”

KEEP Participant: Screening date, December, 2005

National Kidney Foundation «» Kidney Early Evaluation Program «» 2006 s30

diabetes

All 18-30 31-45 46-60 61-75 75+

M

D

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t n e c r e P 0

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KEEP NHANES 99-02

Male Female White Black Other Hisp

Age Gender Race/ethnicity

Normal Pre HTN Stage 1 Stage 2

s t n a p i c i t r a p f o t n e c r e P

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Diabetic Non-diabetic

Male Female White Black OtherHispanic

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White Black OtherHispanic

KEEP NHANES 99-02

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Non-diabetic

KEEP NHANES 99-02

All 18-30 31-45 46-60 61-75 75+ M

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KEEP NHANES 99-02

he KEEP program’s pri-mary focus is the early detection of CKD in in-dividuals with a known history of diabetes or hypertension, or a fami-

ly history of diabetes, hypertension, or kidney disease.

Over 25% of eligible KEEP partici-pants report having diabetes or dia-betic retinopathy. Rates are highest in older participants. Of the par-ticipants who report having diabe-tes, 38% are prehypertensive, based on criteria from the Joint National Committee on Prevention, Detec-tion, Evaluation, and Treatment of High Blood Pressure (JNC 7); the percent with self-reported diabetes increases with the severity of hyper-tension.

Forty-eight percent of KEEP par-ticipants who report having diabe-tes were f0und to have an elevated blood sugar, defined as a fasting glucose greater than 126 mg/dl or a non-fasting glucose exceeding 139 mg/dl.

Elevated blood pressure is more pronounced in black KEEP and NHANES participants compared to whites and people of other races, regardless of diabetic status. El-evated blood pressure occurs in 71 and 33%, respectively, of Hispanic KEEP participants with and with-out diabetes.

A measured glucose greater than the normal limit is nearly eight times more evident in KEEP participants who report having diabetes than in those who report no diabetes.

3.1

Self-reported diabetes in KEEP & NHANES participants, by age, gender, & race/ethnicityKEEP N= 55,220, age & Hispanics; 55,143, gender; 54,011, race. NHANES N= 11,432.

3.2

Blood pressure stages (JNC 7) in KEEP & NHANES participants, by self-reported diabetic statusKEEP N= 53,785. NHANES N= 10,089.

3.3

Elevated blood pressure (JNC 7) in KEEP & NHANES participants, by race/ethnicity, gender, & self-reported diabetic statusKEEP N= 54,305, gender; 53,182, race. NHANES N= 9,421.

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Normal Prehypertension Stage 1 Stage 2

MD detroper- fle s hti

w tnecreP 0

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40KEEP NHANES 99-02

setebaid RS h tiw tne cre P

0

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5018-45 46-60 61+

White Black Other Hispanic

KEEP: Age Race/ethnicity NHANES 99-02: Age Race/ethnicity

**

*

** * *

All 18-30 31-45 46-60 61-75 75+

LN

> esoculg h tiw t ne creP

0

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70Self-reported DM No self-reported DM



<HS&NIns<HS&Ins

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<HS&NIns<HS&Ins

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<HS&NIns<HS&Ins

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3.4

Self-reported diabetes in KEEP & NHANES participants, by blood pressure stage (JNC 7)KEEP N= 54,320. NHANES N= 10,089.

3.5

Measured glucose > normal limit in KEEP participants, by age, gender, race/ethnicity, & self-reported diabetic statusKEEP N= 53,217, age & Hispanic; 53,152, gender; 52,095, race.

3.6

Percent of KEEP & NHANES participants with self-reported diabetes, by education & insurance status, age, & race/ethnicity KEEP N= 51,954, age & Hispanics; 50,952, race. NHANES N= 11,165. *Sample size less than 30 or coefficient of variation not less than 30%.

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hypertension

All 18-30 31-45 46-60 61-75 75+

NTH detroper-f les ht i

w t necreP 0

20

40

60

80KEEP NHANES 99-02



Self-rep. HTN No self-rep.HTN

Per

cent

with

glu

cose

> th

an N

L

0

10

20

30KEEP NHANES 99-02

Male FemaleWhite Black OtherHispanic

esoculg d etavele htiw t ne creP 0

10

20

30 Self-reported HTN


KEEP NHANES 99-02

Male Female

No self-reported HTN

All 18-30 31-45 46-60 61-75 75+

NTH detroper-f les ht i

w t necreP 0

20

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80KEEP NHANES 99-02




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Male Female


All 18-30 31-45 46-60 61-75 75+

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80KEEP NHANES 99-02




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Male Female


ver 52% of KEEP par-ticipants report having hypertension, com-

pared to one-quarter of individuals in the general

population. Proportions of KEEP participants with self-reported hy-pertension increase with age, are compa-

rable in males and females, and are slight-ly higher in blacks compared to whites, individuals of other races, and Hispanics. Elevated blood glucose—a measure glu-cose greater than the normal limit—is more evident in KEEP participants who report having hypertension compared to those not reporting the condition, and is

3.7

Self-reported hypertension in KEEP & NHANES participants, by age, gender, & race/ethnicity KEEP N= 54,506, age & Hispanics; 54,433, gender; 53,353, race. NHANES N= 11,271.

3.9

Measured glucose greater than the normal limit in KEEP & NHANES participants, by gender, race/ethnicity, & self-reported hypertension status KEEP N= 51,956 race; 52,997, gender. NHANES N= 9,717.

3.8

Measured glucose greater than the normal limit in KEEP and NHANES participants, by self-reported hypertension KEEP N= 53,062. NHANES N= 9,717.

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0

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*

Normal glucose Glucose >NL

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75KEEP NHANES 99-02

All 18-30 31-45 46-60 61-75 75+

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Male Female White Black Other Hispanic


<HS&NIns<HS&Ins

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<HS&NIns<HS&Ins

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*

Normal glucose Glucose >NL

NTH detroper -fles hti

w tn ecreP 0

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75KEEP NHANES 99-02

All 18-30 31-45 46-60 61-75 75+

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<HS&NIns<HS&Ins

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100 18-45 46-60 61+



*

Normal glucose Glucose >NLNT

H detroper -fles htiw tn ecreP 0

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75KEEP NHANES 99-02

All 18-30 31-45 46-60 61-75 75+

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<HS&NIns<HS&Ins

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<HS&NIns<HS&Ins

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<HS&NIns<HS&Ins

HS+&NInsHS+&Ins

most prominent in males and individuals of other races. The percent of KEEP par-ticipants with a measured blood pressure greater than Stage 1 (JNC 7) is four times higher in those who report being hyper-tensive, increases with age, and is highest in blacks, at 25.2%, compared to 20, 17.3, and 18.2%, respectively, in whites, indi-

viduals of other races, and Hispanics. In both the KEEP and NHANES popula-tions, and across all age and race/ethnic-ity groups, rates of self-reported hyper-tension are highest in participants with less than a high school education.

3.10

Self-reported hypertension in KEEP and NHANES participants, by glucose levelKEEP N= 53,062. NHANES N= 9,717.

3.11

Measured blood pressure ≥Stage 1 hypertension (JNC 7), in KEEP participants, by age, gender, race/ethnicity, & self-reported hypertensionKEEP N= 53,623, age; 53,554, gender; 52,485 race.

3.12

Self-reported hypertension in KEEP & NHANES participants, by education & insurance status, age, & race/ethnicityKEEP N= 51,796, age; 50,808, race. NHANES N= 9,717. *Sample size less than 30 or coefficient of variation not less than 30%.

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All 18-30 31-45 46-60 61-75 75+

esaesid ral ucsavoidr ac ht iw

% 0

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Race/ethnicityGenderAge

All 18-30 31-45 46-60 61-75 75+

esaesid ral ucsavoi dr ac h tiw

% 0

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All 18-30 31-45 46-60 61-75 75+esaesid ral ucsavoidr ac ht i

w % 0

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All 18-30 31-45 46-60 61-75 75+

esaesid ral ucsavoi dr ac h tiw

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cardiovascular disease

3.13

Cardiovascular disease in KEEP participants, by age, gender, & race/ethnicity

KEEP N= 54,173, age; 54,111, gender; 53,030, race.

3.14

Cardiovascular disease in KEEP participants with & without CKD, by age, gender, & race/ethnicityKEEP N= 45,311 age & gender; 44,400, race.

early 18% of KEEP participants report a history of car-diovascular disease (CVD), including a heart attack, by-

pass surgery, angioplasty, stroke, heart failure, peripheral vascular disease, or arrhythmia. Rates are most pronounced in older participants, and reach 35% in those age 75 and older. Twenty percent of white participants report having CVD, compared to 17, 15.5, and 15.1%, respectively, of blacks, individuals of other races, and Hispanics.

Nearly 27% of KEEP participants with CKD report a diagnosis of CVD, com-pared to 15% in those without the dis-ease. By race/ethnicity, rates of CVD are 10–13% higher in participants with CKD compared to those not having the diag-nosis. The most common risk factor for cardiovascular disease reported by KEEP participants with CKD is an elevated blood pressure—nearly 77% of partici-pants with cardiovascular disease have associated elevated blood pressure. Rates of cardiovascular disease are highest in KEEP participants who have less than a high school education.

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18-45 46-60 61+

SRDM BMI ≥30 Elv BP Hist of Smoking

WHOAnemia


WHOAnemia

0

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CKD No CKD

Without cardiovascular diseaseWith cardiovascular disease

rotcaf ks ir htiw tnec re P

esaesid ralucsavoidrac ht iw t nec reP

0

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40 KEEP: Age Race/ethnicity NHANES 99-02: Age Race/ethnicityWhite Black

Other Hispanic

** *

*

* *

* ** *

<HS&NIns<HS&Ins

HS+&NInsHS+&Ins

<HS&NIns<HS&Ins

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<HS&NIns<HS&Ins

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<HS&NIns<HS&Ins

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18-45 46-60 61+


WHOAnemia


WHOAnemia

0

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CKD No CKD

Without cardiovascular diseaseWith cardiovascular disease

rotcaf ks ir htiw tnec re P

esaesid ralucsavoidrac ht iw t nec reP

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40 KEEP: Age Race/ethnicity NHANES 99-02: Age Race/ethnicityWhite Black

Other Hispanic

** *

*

* *

* ** *

<HS&NIns<HS&Ins

HS+&NInsHS+&Ins

<HS&NIns<HS&Ins

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<HS&NIns<HS&Ins

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<HS&NIns<HS&Ins

HS+&NInsHS+&Ins

3.15

Reported risk factors in KEEP participants with & without cardiovascular diseaseKEEP N= 41,354.

3.16

Percent of KEEP & NHANES participants with cardiovascular disease, by education & insurance status, age, & race/ethnicityKEEP N=52,398, age; 51,381, race. NHANES N= 9,990, participants age 20 and older. *Sample size less than 30 or coefficient of variation not less than 30%.

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OW: 32.9

EO: 8.8

UW: 2.0

OW: 34.2 EOB: 4.9

KEEP NHANES 99-02

UW: 0.8

N: 21.7

OB: 35.8

N: 33.6

OB: 25.3

Male Female

stnapicitrap fo tne creP

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KEEP NHANES 99-02UnderweightNormalOverweight

ObeseExtremely obese


stnapicitrap fo tnecreP

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60




Northeast Midwest South West


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OW: 32.9

EO: 8.8

UW: 2.0

OW: 34.2 EOB: 4.9

KEEP NHANES 99-02

UW: 0.8

N: 21.7

OB: 35.8

N: 33.6

OB: 25.3

Male Female


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OW: 32.9

EO: 8.8

UW: 2.0

OW: 34.2 EOB: 4.9

KEEP NHANES 99-02

UW: 0.8

N: 21.7

OB: 35.8

N: 33.6

OB: 25.3

Male Female


0

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Male Female





0

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OW: 32.9

EO: 8.8

UW: 2.0

OW: 34.2 EOB: 4.9

KEEP NHANES 99-02

UW: 0.8

N: 21.7

OB: 35.8

N: 33.6

OB: 25.3

Male Female


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obesity

3.17

Percent distribution of KEEP & NHANES participants, by BMI categoryKEEP N= 54,466. NHANES N= 10,132.

3.18

BMI in KEEP & NHANES participants, by gender & BMI categoryKEEP N= 54,396. NHANES N=10,132.

3.20

BMI in KEEP participants, by U.S. Census RegionKEEP N= 54,446.

3.19

BMI in KEEP & NHANES participants, by race/ethnicityKEEP N= 53,292. NHANES N=10,132.

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Perc

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g/m

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7518-45 46-60 61+

KEEP: Age Race/ethnicity NHANES 99-02: Age Race/ethnicityWhite Black

Other Hispanic

NormalPre HTNStage 1 Stage 2NormalPre HTNStage 1 Stage 2

stnapicitra p fo tnecr eP

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Diabetes Hypertension

NTH ro

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UWNOW OBEOB


KEEP NHANES 99-02

*

BMI<25 (kg/m2)BMI 25-<30 (kg/m2)BMI 30+ (kg/m2)

<HS&NIns<HS&Ins

HS+&NInsHS+&Ins

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Perc

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UWNOW OBEOB


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*


<HS&NIns<HS&Ins

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Perc

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UWNOW OBEOB


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*


<HS&NIns<HS&Ins

HS+&NInsHS+&Ins

<HS&NIns<HS&Ins

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<HS&NIns<HS&Ins

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<HS&NIns<HS&Ins

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3.22

BMI in KEEP & NHANES participants, by measured blood pressure (JNC 7)KEEP N= 53,626. NHANES N= 9,781.

3.21

KEEP & NHANES participants with self-reported diabetes or hypertension, by BMI categoryKEEP N= 53,321; NHANES N= 10,127, diabetes; 9,998, hypertension. *Sample size less than 30 or coefficient of variation not less than 30%.

3.23

Percent of KEEP & NHANES participants with a BMI ≥30 kg/m2, by age, race/ethnicity, education, & insurance status KEEP N= 51,723, age; 50,732, race. NHANES N= 9,959.

ver three-fourths of KEEP participants are classified as being overweight to ex-tremely obese, compared

to a 64% rate in the general population.

Of eligible KEEP participants, 80% of males and 76% of females are, at the least, overweight, and females have a higher rate of overall obesity than males, at 47 and 40%, respectively.

By race/ethnicity, over 40% of black KEEP partici-pants are classified as obese and 12% are extremely obese, compared to 33.3 and 7.3% of whites.

By Census region, the percent of KEEP participants who are obese to extremely obese ranges from 39% in the West to 48% in the Midwest.

Obesity is more evident in participants with self-reported hypertension compared to those with self-reported diabetes—61.1% compared to 31.3%, while 56% of KEEP participants diagnosed with Stage 2 hypertension (JNC 7) have a BMI equal to or ex-ceeding 30 kg/m2.

Irrespective of insurance and educational status, the highest rates of obesity are generally found in KEEP participants age 46–60, and black participants are more prone to this condition.

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Smoking Used to smoke Never smoked

stneitap fo tne cre P

0

20

40

60

KEEP NHANES 99-02



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80

100


KEEP NHANES 99-02


MD detrope r-fle s h ti

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smoking history

3.24

Percent distribution of KEEP & NHANES participants, by smoking statusKEEP N= 51,808. NHANES N= 10,261.

3.25

Smoking status in KEEP & NHANES participants, by race/ethnicityKEEP N= 50,726. NHANES N= 10,261.

3.26

Self-reported diabetes in KEEP & NHANES participants, by smoking statusKEEP N= 51,336. NHANES N=10,258, participants age 20 and older.

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yrot si h gn ikoms hti

w tn ecre P

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8018-45 46-60 61+

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25

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DKC hti

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<HS&NIns<HS&Ins

HS+&NInsHS+&Ins

<HS&NIns<HS&Ins

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<HS&NIns<HS&Ins

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8018-45 46-60 61+

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<HS&NIns<HS&Ins

HS+&NInsHS+&Ins


w tn ecre P

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8018-45 46-60 61+

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Other Hispanic




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<HS&NIns<HS&Ins

HS+&NInsHS+&Ins

<HS&NIns<HS&Ins

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<HS&NIns<HS&Ins

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<HS&NIns<HS&Ins

HS+&NInsHS+&Ins

3.29

KEEP & NHANES participants with a history of smoking, by education & insurance status, age, & race/ethnicityKEEP N= 48,920. NHANES N= 10,045.

3.27

Self-reported hypertension in KEEP & NHANES participants, by smoking statusKEEP N= 51,181. NHANES N= 10,137, participants age 20 and older.

3.28

CKD in KEEP & NHANES participants, by smoking statusKEEP N= 42,571. NHANES N= 8,700.

hirteen percent of KEEP participants report that they currently smoke, compared to 25% of the general popu-lation. Nearly 30% used to

smoke, and 57.4% report never having smoked.

In the KEEP population, smoking is most common in individuals of other races. Almost 31% of those who used to smoke report having diabetes, compared to 24% who never smoked and 22% who currently smoke.

Close to 60% of KEEP participants who used to smoke report being hypertensive, compared to 51% who never smoked and 46% who currently smoke.

One-third of eligible KEEP participants who used to smoke report a diagnosis of CKD, in comparison to 28% of those who never smoked, and 24% who cur-rently smoke.

In both the KEEP and NHANES popu-lations, the percent of participants with a history of smoking is greatest in those with less than a high school education.

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Kidney stone

Kidney disease

Both

noitidnoc htiw t necreP

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4

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8

All Male Female

noitidnoc htiw t ne creP

0

3

6

9

12

15

All Male Female

noitidnoc htiw reb

muN

0

1,000

2,000

3,000

4,000

5,000 Total in category Percent in category

All NE MW S W0

1,000

2,000

3,000

4,000

5,000

All NE MW S W

noitidnoc htiw tnecreP

0

3

6

9

12

15Total in category Percent in category

AllWhite

BlackOther

Hispanic AllWhite

BlackOther

Hispanic

noit id no c htiw r eb

muN

noitidnoc htiw reb

muN

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2,000

3,000

4,000

5,000

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6

9

12


Kidney diseaseKidney stonesKidney dis./stones

Kidney diseaseKidney stonesBoth


Kidney stone

Kidney disease

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All Male Female


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3

6

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15

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3,000

4,000


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3,000

4,000

5,000

All NE MW S W

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9

12


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BlackOther

Hispanic AllWhite

BlackOther

Hispanic


muN

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muN

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2,000

3,000

4,000

5,000


0

3

6

9

12





Kidney stone

Kidney disease

Both


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2

4

6

8

All Male Female


0

3

6

9

12

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3,000

4,000


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1,000

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3,000

4,000

5,000

All NE MW S Wnoitidnoc hti

w tnecreP0

3

6

9

12


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BlackOther

Hispanic AllWhite

BlackOther

Hispanic


muN

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muN

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2,000

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4,000

5,000


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6

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All Male Female

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muN

0

1,000

2,000

3,000

4,000


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1,000

2,000

3,000

4,000

5,000

All NE MW S Wnoitidnoc hti

w tnecreP0

3

6

9

12


AllWhite

BlackOther

Hispanic AllWhite

BlackOther

Hispanic


muN

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muN

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2,000

3,000

4,000

5,000


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6

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12





3.33

Self-reported kidney problems in KEEP participants, by U.S. Census RegionKEEP N= 53,526.

3.32

Self-reported kidney problems in KEEP participants, by race/ethnicityKEEP N= 52,435.

3.31

Self-reported kidney problems in KEEP participants, by genderKEEP N= 53,489.

3.30

Self-reported kidney problems in KEEP participantsKEEP N= 53,545.

evidence of kidney disease

f eligible KEEP par-ticipants, more than 4,100 report having kidney stones (8.0%),

while 2.2% report hav-ing kidney problems. Kid-

ney stones are more common in males than in females.

Eleven percent of white participants re-port kidney stones, compared to 4, 7, and 7.6%, respectively, of blacks, individuals of other races, and Hispanics. Kidney stones are reported by 8.0% of KEEP par-

ticipants living in the South and West, 7.4% in the Northeast, and 6.5% in the Midwest.

In the KEEP population, 13.5% of whites are classified as having Stage 2 CKD. Stage 2 CKD is evenly distributed in blacks, people of other races, and His-panics, ranging form 20.4–20.7%. In NHANES participants, Stage 3 CKD is more prominent in whites, at 20.1%, followed by blacks, individuals of other races, and Hispanics, at 15.5, 14.0, and 12.0%, respectively.

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0

20

40

60

80

All White Black Other Hispanic0

20

40

60

80

KEEP

NHANES 99-02

stnapicit rap fo tnecre P

Stage 1 Stage 2

Stage 3 Stages 4-5

* *

D KC hti

w tnecreP

0

20

40

60

8018-45 46-60 61+



* *

<HS&NIns<HS&Ins

HS+&NInsHS+&Ins

<HS&NIns<HS&Ins

HS+&NInsHS+&Ins

<HS&NIns<HS&Ins

HS+&NInsHS+&Ins

<HS&NIns<HS&Ins

HS+&NInsHS+&Ins

0

20

40

60

80

All White Black Other Hispanic0

20

40

60

80

KEEP

NHANES 99-02

stnapicit rap fo tnecre P

Stage 1 Stage 2

Stage 3 Stages 4-5

* *

D KC hti

w tnecreP

0

20

40

60

8018-45 46-60 61+



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<HS&NIns<HS&Ins

HS+&NInsHS+&Ins

<HS&NIns<HS&Ins

HS+&NInsHS+&Ins

<HS&NIns<HS&Ins

HS+&NInsHS+&Ins

<HS&NIns<HS&Ins

HS+&NInsHS+&Ins

3.34

CKD in KEEP & NHANES participants, by CKD stage & race/ethnicityKEEP N= 12,700, NHANES N= 1,505. *Sample size less than 30 or coefficient of variation not less than 30%.

3.35

CKD in KEEP & NHANES participants, by education & insurance status, age, & race/ethnicity KEEP N= 43,008, age; 42,240, race. NHANES N=9,567. *Sample size less than 30 or coefficient of variation not less than 30%.

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60 CKD Diabetes (SR) HTN (SR) Obesity Smoking

Self-rep DM Self-rep NDM

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100 DM (family history) HTN (family history)KD (family history)


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60 CKD Diabetes (SR) HTN (SR) Obesity Smoking

Self-rep DM Self-rep NDM

yrotsih ylima f ht i

w tne cr eP

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75

100 DM (family history) HTN (family history)KD (family history)

family history & comorbidity

3.36

Risk factors in KEEP participants, by U.S. Census RegionAcross all U.S. Census Regions, hypertension is the most commonly reported risk factor for KEEP participants, ranging from 47.4–55.4%. KEEP N= 41,227.

3.37

Family history of diabetes, hypertension, or kidney disease in KEEP participants, by self-reported diabetic statusKEEP N= 50,381.

n KEEP participants, hyper-tension is the most commonly reported risk factor in all U.S. Census Regions, ranging from 47.4% in the West to 55.4% in

the South. Proportions of diabetes are similar across all regions, ranging from 25.2–27.6%, and approaching 30% in participants with CKD.

Eighty-two percent of KEEP participants who report no diabetes have a family history of hypertension; in those with self-reported diabetes, a family history of hypertension is evident in 74%. The per-cent of KEEP participants with a family

history of either diabetes, hypertension, or kidney disease does not appear to be related to the severity of hypertension and KEEP participant family members are more likely than KEEP participants to experience a cardiac event.

Two-thirds of KEEP participants with Stage 1 (JNC 7) hypertension report a family history of diabetes, and 80% report a family history of hypertension. And KEEP participant family members are far more likely than KEEP participants to have undergone a cardiac procedure or have experienced a cardiac event.

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yrotsih ylimaf ht i

w tnecreP

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25

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75

100DM (fam. history) HTN (fam. history) KD (fam. history)

DM (fam. history) HTN (fam. history) KD (fam. history)

HA BPS Angio Stroke HF Arrhyth PVD

tneve caidr ac htiw tn ecre P

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Normal Stage 1 Stage 2 Stage 3 Stage 4-5

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100Family memberParticipant


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3.38

Family history of diabetes, hypertension, or kidney disease in KEEP participants, by measured blood pressure (JNC 7)KEEP N= 49,994.

3.39

KEEP participants with a family member who has had a cardiac event & who have suffered the same cardiac event as a family memberKEEP N= 53,760, heart attack; 10,117, heart bypass surgery; 10,022, heart angioplasty; 53,651, stroke; 10,007, heart failure; 10,094, arrhythmia; 55,220, PVD. KEEP family member N= 52,281, heart attack; 7,950, heart bypass surgery; 51,881, stroke; 7,535, heart failure; 7,240 arrhythmia; 55,220, PVD.

3.40

Family history of diabetes, hypertension, or kidney disease in KEEP participants, by CKD stageKEEP N= 41,643.

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Yes No NA

Perc

ent r

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follo

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50

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BP Glucose Urine CR CCR Hgb Oth

Perc

ent w

ho s

aw a

phy

sici

an

0

20

40

60

Percent of participants

0 10 20 30 40

Other reasons

Not recommended

I have no time

No insurance

I don't believe it is necessary

Cannot afford

No physician

Not able to get to appt

Don't know

Cannot take time off

MD said not necessary

No transportation

Yes No NA

Perc

ent r

etur

ning

follo

wup

form

0

25

50

75


Perc

ent w

ho s

aw a

phy

sici

an

0

20

40

60


0 10 20 30 40

Other reasons

Not recommended

I have no time

No insurance


Cannot afford

No physician


Don't know



No transportation

Yes No NA

Perc

ent r

etur

ning

follo

wup

form

0

25

50

75


Perc

ent w

ho s

aw a

phy

sici

an

0

20

40

60


0 10 20 30 40

Other reasons

Not recommended

I have no time

No insurance


Cannot afford

No physician


Don't know



No transportation

All 2000+2001 2002 2003 2004 2005

% o

f com

plet

ing

follo

wup

form

0

10

20

30

40

intervention

3.43

Reason for seeing a physician about test results among KEEP participants who return their followup formsKEEP N= 10,889 .

3.42

KEEP participants who return their followup forms, by seeing a physicianKEEP N= 16,194.

3.44

Reasons why KEEP participants do not see a physician after receiving abnormal test resultsKEEP N=4,758.

3.41

KEEP participants who complete their followup forms, by yearKEEP N= 16,194.

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OTC medications Prescription Injection OtherPerc

ent w

ith m

edic

al in

terv

entio

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0

10

20

30

40

Monitor BS Diet adjust. Drug therapy Insulin OtherPerc

ent w

ith m

edic

al in

terv

entio

nPe

rcen

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med

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inte

rven

tion

0

10

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50

Monitored BP Diet adjust. Drug therapy Other0

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ent w

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ent w

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ent w

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ent w

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50

3.45

KEEP participants who learn they have anemia, & have a medical interventionKEEP N= 352.

3.46

KEEP participants who learn they have diabetes, & have a medical interventionKEEP N= 1,064.

3.47

KEEP participants who learn they have high blood pressure, & have a medical interventionKEEP N= 2,248.

ntervention following the KEEP evaluation is an integral part of the KEEP program. On their study followup forms, 67% of KEEP participants report seeing

a physician after the study. Of these in-dividuals, 50% have seen a physician be-cause of abnormal blood pressure results, while 46.8% have consulted a physician because of an abnormal urine test.

For a variety of reasons, some participants do not see a physician after receiving no-tification of an abnormal test; of these,

12.5% report having no insurance while 12% do not believe the visit is necessary.

In KEEP participants who learn they have anemia, 32% are placed on over-the-counter medications and 20% receive a prescription drug. Forty-two percent of participants who learn they have diabe-tes are told to monitor their blood sugar, while 39% undergo drug therapy; in par-ticipants who learn they have high blood pressure, 42.6% are told to monitor their blood pressure, and 47% are placed on prescription drugs.

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chapter highlights

Figure 3.1Over 25% of eligible KEEP participants report having diabetes or diabetic retinopathy. Rates are highest in older participants.

Figure 3.4 The percent with self-reported diabetes increases with the severity of hypertension.

Figure 3.7Proportions of KEEP participants with self-reported hypertension increase with age, are comparable in males and females, and are slightly higher in blacks compared to whites, individuals of other races, and Hispanics.

Figure 3.10The proportion of KEEP and NHANES participants who report having hypertension is greatest in those with an elevated glucose.

Figure 3.13Nearly 18% of KEEP participants report a history of cardiovascular disease.

Figure 3.17Over three-fourths of KEEP participants are classified as being overweight to extremely obese, compared to a 64% rate in the general population.

Figure 3.24Thirteen percent of KEEP participants report that they currently smoke, compared to 25% of the general population. Nearly 30% used to smoke, and 57.4% report never having smoked.

Figure 3.42On their study followup forms, 67% of KEEP participants report seeing a physician after the study.

JNC 7 HyperteNsioNNormalsystolic <120 mmHg & diastolic <80 mmHg

prehypertensionsystolic 120-139 mmHg or diastolic 80-89

mmHg

stage 1systolic 140-159 mmHg or diastolic 90-99

mmHg

stage 2systolic ≥160 mmHg or diastolic ≥100 mmHg

elevated blood pressure (ebp) (JNC 7)dM or CKd:systolic: ≥130 mmHg or diastolic: ≥80 mmHgNo dM or CKd:systolic: ≥140 mmHg or

diastolic: ≥90 mm Hg

diabetesSelf-reported diabetes Elevated blood sugar

GluCose Greater tHaN tHe NorMal liMitFasting: >126 mg/dlNon-fasting: >139 mg/dl

risK faCtors for CardiovasCular diseaseDiabetesBMI ≥ 30 kg/m2

Smoking historyAnemia (WHO definition)Elevated blood pressure

Cvd defiNitioN: KeepParticipant reporting any of the following

cardiac events: heart attack, heart by-pass surgery, heart angioplasty, stroke, heart failure, stroke, PVD, or arrhythmia

Cvd defiNitioN (NHaNes)Participant reporting any of the following

cardiac diseases: congestive heart failure, coronary heart disease, angina/angina pectoris, heart attack, or stroke

CKd defiNitioNIf eGFR by K/DOQI MDRD <60 ml/min/1.73

m2 or eGFR ≥60 ml/min/1.73 m2 and abnormal albumin/creatinine ratio (ACR ≥30mg/g)

CKd staGesStage 1: eGFR ≥90, ACR ≥30 mg/gStage 2: eGFR 60–89, ACR ≥30 mg/gStage 3: eGFR 30–59Stage 4: eGFR 15–29Stage 5: eGFR <15 or dialysis

u.s. CeNsus reGioNsNE: NortheastMW: MidwestS: SouthW: West

body Mass iNdex CateGoriesUW: underweight, BMI <18.5N: normal, BMI 18.5–24.9OW: overweight, BMI 25–29.9OB: obese, BMI 30–39.9EOB: extremely obese, BMI ≥40

eduCatioN & iNsuraNCe<HS&NIns: Less than a high school education,

& no insurance<HS&Ins: Less than a high school education,

& insuranceHS+&NIns: High school education or greater,

& no insuranceHS+&Ins: High school education or greater, &

insurance

Cardia eveNt defiNitioNsHA: Heart AttackBPS: Heart by-pass surgeryAngio: AngioplastyHF: Heart failureArrhyth: ArrhythmiaPVD: Peripheral vascular disease

Health history - CacheFlykidneyfoundation.cachefly.net/keep/adr2006/04chapter3healthhistory.pdf ·...

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