The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form

The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. severe CKD using the NKF-KDOQI system. For example, the prevalence of hyperparathyroidism was 9.1%, 11.1%, 28.2% and 72.5% for Stages 1, 2, 3 and 4, respectively. Similarly the prevalence of anemia, acidosis and hyperphosphatemia increased progressively from MK-0752 Stage 2 through 4. With the alternative system, the prevalence of anemia, hyperphosphatemia, hypertension and hyperparathyroidism was lower in Stage 3 compared to Stage 2. For example, the prevalence of hyperparathyroidism was 13.5%, 40.3%, 22.2%, and 63.4% for stages 1, 2, 3 and 4, respectively. Applying the alternative system, participants without each complication were more likely to be appropriately reclassified to lower stages (for example, overall net reclassification index of 6.5% for hyperparathyroidism). However, participants with complications (except for hypoalbuminemia) were more likely to be inappropriately reclassified to lower stages. == Limitations == Use of single creatinine to estimate GFR and single measure to assess ACR. Small number of participants with CKD Stage 4. == Conclusions == The NKF-KDOQI system may better identify patients with certain concurrent CKD complications compared to systems using eGFR and proteinuria. The National Kidney Foundations Kidney Disease Outcome Quality Initiative (NKF-KDOQI) defines chronic kidney disease (CKD) by the presence of reduced estimated glomerular filtration rate (eGFR) or markers of kidney damage, generally determined by elevated proteinuria. However, the severity of CKD has been primarily classified by level of eGFR(1,2). Although this classification system led to improved awareness of CKD(35), it has been criticized on the grounds that it does not sufficiently differentiate among patients who are and are not likely to have adverse outcomes(6). Recently, a KDIGO (Kidney Disease International Global Outcomes) consensus conference proposed that CKD be classified using both proteinuria and eGFR(7). The potential advantages of such an alternative system includes improved specificity for classifying people at low risk of adverse outcomes, including progressive kidney disease and mortality, into lower CKD stages(8). While a system using both proteinuria and eGFR may more accurately stage individuals with respect to their risk for future adverse outcomes, it is unknown whether such an approach would classify people with concurrent CKD complications better than eGFR alone. We previously demonstrated, in a general population sample, that albuminuria, a specific type of proteinuria, and eGFR are differentially associated with certain concurrent CKD complications (anemia, acidosis, hyperphosphatemia, hypoalbuminemia, hyperparathyroidism and hypertension), and that other than hypoalbuminemia, eGFR had a stronger association with each of these CKD complications than albuminuria(9). We sought to Rabbit Polyclonal to KAP1 evaluate the effect of using both eGFR and proteinuria to classify patients MK-0752 with MK-0752 respect to concurrent complications of CKD. Therefore, we calculated the prevalence of these complications of CKD across categories of a recently published CKD risk stratification system that incorporates both eGFR and proteinuria using data from the US National Health and Nutrition Examination Survey (NHANES)(8). For comparison, the prevalence of these six complications were calculated by CKD MK-0752 stage defined using the NKF-KDOQI classification system. == Methods == == Study Population == The NHANES are cross-sectional, multistage, stratified, clustered probability samples of the US civilian noninstitutionalized population conducted by the National Center for Health Statistics. The NHANES included in the current analysis were conducted from 19881994 in 2 phases (19881991 and 19911994) and from 19992006 in 4 phases MK-0752 (19992000, 20012002, 20032004, 20052006). Data from all phases were combined herein following National Center for Health Statistics recommendations(10). The current analysis was restricted to participants aged 20 years.