Prevalence and Associations of Anemia of CKD: Kidney Early Evaluation Program (KEEP) and National Health and Nutrition Examination Survey (NHANES) 1999-2004

https://doi.org/10.1053/j.ajkd.2007.12.019Get rights and content

Background

Early identification of anemia of chronic kidney disease may be important for the development of preventive strategies. We compared anemia prevalence and characteristics in the National Kidney Foundation Kidney Early Evaluation Program (KEEP) and National Health and Nutrition Examination Survey (NHANES) 1999-2004 populations.

Methods

Clinical, demographic, and laboratory data were collected from August 2000 to December 31, 2006, from participants in KEEP, a community-based health-screening program targeting individuals 18 years and older with diabetes, hypertension, or family history of kidney disease, diabetes, or hypertension. Anemia was defined as hemoglobin level less than 13.5 g/dL for men and less than 12.0 g/dL for women (Kidney Disease Outcomes Quality Initiative [KDOQI] 2006) or less than 13.0 g/dL for men and less than 12.0 g/dL for women (World Health Organization [WHO]).

Results

In KEEP (n = 70,069), 68.3% of participants, and in NHANES (n = 17,061), 52% of participants, were women. African Americans represented 33.9% of the KEEP and 11.2% of the NHANES cohorts, and Hispanics comprised 12.4% of KEEP and 13.2% of NHANES. Using the KDOQI classification, anemia was present in 13.9% and 6.3% of KEEP and NHANES participants, whereas using the WHO classification, anemia was present in 11.8% and 5.3%, respectively. In adjusted analysis of KEEP data, KDOQI-defined anemia was significantly more likely in men (odds ratio [OR], 1.30; 95% confidence interval [CI], 1.23 to 1.37); this pattern was reversed when using WHO-defined anemia (OR, 0.68; 95% CI, 0.64 to 0.72). Adjusted odds of anemia were greater for African American than white KEEP participants (OR, 2.98; 95% CI, 2.80 to 3.16; OR, 3.00; 95% CI, 2.81 to 3.20 for KDOQI- and WHO-defined anemia, respectively).

Conclusion

Anemia was twice as common in the targeted KEEP chronic kidney disease screening program cohort than in the NHANES sample population. African Americans had a 3-fold increased likelihood of anemia compared with whites. Targeted screening can identify anemia in a high-risk population.

Section snippets

Definitions

KEEP and the NHANES database are fully described elsewhere in this supplement.15 Disease definitions are as follows. History of diabetes is defined as self-reported diabetes or retinopathy, and history of hypertension, as self-reported hypertension. Anemia is defined as hemoglobin level less than 13.5 g/dL (<135 g/L) for men and less than 12.0 g/dL (<120 g/L) for women (KDOQI 2006)10 or less than 13.0 g/dL (<130 g/L) for men and less than 12.0 g/dL (<120 g/L) for women (WHO). Obesity is defined

Results

The population screened for the KEEP program included 70,069 eligible participants. Anemia data were collected for all participants and data for key variables were collected for 51,727 (73.8%). The NHANES 1999-2004 cohort included 17,061 adult participants aged 18 years and older. Compared with NHANES, women and African Americans were overrepresented in KEEP. Of KEEP participants, 68.3% were women compared with 52% of NHANES participants (Table 1). Racial distribution in the KEEP population was

Discussion

Our study highlights several major differences between a targeted community-based screening program (KEEP) and a generalizable population health survey (NHANES 1999-2004). Greater percentages of KEEP participants were at risk of CKD and anemia, including African Americans, who were 3 times more prevalent in KEEP than NHANES. Risk factors for CKD and CVD5, 9, 14 also were better represented in KEEP populations than in NHANES. For example, obesity was 1.4 times; hypertension was 2 times; and

Acknowledgements

In addition to the authors listed, the Kidney Early Evaluation Program (KEEP) Investigators are Dennis Andress, MD, David Calhoun, MD, Bruce Johnson, MD, Claudine T. Jurkovitz, MD, MPH, Chamberlain I. Obialo, MD, Lesley A. Stevens, MD, and Michael G. Shlipak, MD.

The authors thank Shane Nygaard, BA, and Nan Booth, MSW, MPH of the Chronic Disease Research Group for manuscript preparation and manuscript editing, respectively.

Support: KEEP is a program of the National Kidney Foundation Inc and is

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