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Epidemiology and Outcomes
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Prevalence of Low Glomerular Filtration Rate in Nondiabetic Americans: Third National Health and Nutrition Examination Survey (NHANES III)

Catherine M. Clase, Amit X. Garg and Bryce A. Kiberd
JASN May 2002, 13 (5) 1338-1349; DOI: https://doi.org/10.1097/01.ASN.0000013291.78621.26
Catherine M. Clase
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Amit X. Garg
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Bryce A. Kiberd
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    Figure 1. Nondiabetic adults in NHANES III. Weighted distribution of level of predicted GFR (MDRD categories) in ml/min per 1.73 m2 by age (in decades) and stratified by race and gender.

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    Figure 2. Nondiabetic adults in NHANES III. Weighted distribution of level of creatinine clearance (Cockcroft-Gault [CG] categories) in ml/min by age (in decades) and stratified by race and gender.

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    Figure 3. Nondiabetic adults in NHANES III. Weighted distribution of level of predicted GFR (Couchoud categories) in ml/min per 1.73 m2 by age (in decades) and stratified by race and gender. For (L/creatinine) ×100, the cutpoint of 80 ml/min corresponds to serum creatinine of 1.25 mg/dl; 60 ml/min to 1.67 mg/dl; and 30 ml/min to 3.33 mg/dl.

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    Figure 4. Nondiabetic adults in NHANES III. Weighted distribution of level of predicted GFR (reciprocal of creatinine categories) in dl/mg by age (in decades) and stratified by race and gender. For (L/creatinine) × 100, the cutpoint of 80 ml/min corresponds to serum creatinine of 1.25 mg/dl; 60 ml/min to 1.67 mg/dl; and 30 ml/min to 3.33 mg/dl.

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    Table 1.

    NHANES III participants who met inclusion criteria. Comparison of those selected for analysis with those excluded on the basis of missing biochemical data for clearance calculationsa

    ParameterExcludedIncludedP
    a Data are mean (standard error [SE]) for continuous variables and proportions (SE) for discrete variables. Missing data: all variables had 98.6% or more complete information. P values for proportions were assessed by χ2 test, and for continuous variables with t test for independent samples.
    n36513,251
    Age
        20 to 39 yr53.6% (4.3)48.4% (1.0)0.2
        40 to 59 yr20.0% (3.1)31.9% (0.5)<0.01
        60 to 79 yr21.1% (2.1)17.1% (0.7)0.08
        ≥80 yr5.4% (1.5)2.6% (0.8)0.03
    Gender (women)49.9% (4.2)51.9% (0.4)0.6
    Race (black)19.1% (2.0)11.0% (0.2)<0.001
    Past medical history
        hypertension22.8% (3.2)21.9% (0.7)0.7
        myocardial infarction6.6% (1.3)2.7% (0.3)0.005
        stroke1.2% (0.6)1.4% (0.2)0.80
        congestive heart failure3.1% (1.0)1.5% (0.1)0.15
        smoking (ever)52.6% (3.3)54.7% (0.8)0.53
        kidney stones6.8% (2.7)5.4% (0.4)0.65
    Systolic BP (mmHg)122 (1.2)121 (0.4)0.33
    Diastolic BP (mmHg)73 (0.9)74 (0.2)0.46
    • View popup
    Table 2.

    Further characteristics of the 13,251 NHANES III nondiabetic adult participants included in the analysisa

    ParameterConventional UnitsSI Units
    a Data are mean (SE). Missing data: all variables had 99.4% or more complete information.
    b Body surface area (m2) = 0.20247 × [height (m)]0.725 × [weight (kg)]0.425 (58).
    c Body mass index = [weight (kg)]/[height (m)]2.
    d MDRD GFR (ml/min per 1.73 m2) = 170 × [serum creatinine (mg/dl)]−0.999 × [age]−0.176 × [0.762 if patient is female] × [1.180 if patient is black] × [serum urea nitrogen (mg/dl)]−0.170 × [serum albumin (g/dL)]0.318.
    e Cockcroft-Gault creatinine clearance = ([140 − age] × [weight (kg)])/(72 × [serum creatinine (mg/dl)]) × [0.85 if female].
    Body wt75 (0.3) kg
    Height169 (0.2) cm1.69 (0.002) m
    Body surface areab1.85 (0.004) m2
    Body mass indexc26.3 (0.08) kg/m2
    MDRD GFRd77 (0.4) ml/min per 1.73m20.74 (0.004) ml/s per m2
    Cockcroft-Gault creatinine clearancee89 (0.9) ml/min1.48 (0.02) ml/s
    Serum creatinine1.07 (0.002) mg/dl94.5 (0.2) mmol/L
    Serum urea14.0 (0.08) mg/dl5.0 (0.03) mmol/L
    Serum cholesterol203 (0.8) mg/dl5.26 (0.02) mmol/L
    Serum albumin4.20 (0.01) g/dl42.0 (0.1) g/L
    Glycated hemoglobin5.2 (0.01)%
    • View popup
    Table 3.

    Nondiabetic adults in NHANES III 95% confidence intervals (CI) for weighted distribution of level of GFRa

    GFR Category (ml/min per 1.73m2)20 to 29 yr30 to 39 yr40 to 49 yr50 to 59 yr60 to 69 yr70 to 79 yr≥80 yrTotal
    a All values are % within race-gender-age stratum. GFR is categorized according to the MDRD equation and stratified by age (in decades), race, and gender. Point estimates for this analysis are shown in Figure 1.
    ≥80
        white male75 to 8354 to 6331 to 4218 to 2511 to 176.2 to 111.4 to 4.743 to 48
        white female61 to 6941 to 4919 to 269.3 to 174.7 to 9.71.6 to 4.00.7 to 3.730 to 34
        black male89 to 9474 to 8260 to 7242 to 5630 to 4413 to 333.8 to 3569 to 73
        black female88 to 9474 to 8254 to 6527 to 4214 to 277.6 to 220 to 8.063 to 68
    60 to 79
        white male17 to 2436 to 4555 to 6561 to 6955 to 6244 to 5428 to 4243 to 47
        white female30 to 3946 to 5561 to 6959 to 6949 to 5735 to 4521 to 3048 to 52
        black male5.4 to 1017 to 2526 to 3938 to 5238 to 5436 to 5429 to 6323 to 27
        black female6.0 to 1117 to 2434 to 4351 to 6540 to 6038 to 6020 to 4826 to 30
    30 to 59
        white male0 to 1.20 to 1.42.0 to 5.49.2 to 1823 to 3035 to 4654 to 688 to 10
        white female0.1 to 1.32.3 to 5.38.7 to 1619 to 2735 to 4451 to 6164 to 7215 to 20
        black male0 to 1.10 to 0.70.3 to 2.52.9 to 8.011 to 2220 to 4121 to 493.2 to 4.6
        black female0 to 0.20.1 to 1.80.6 to 2.93.1 to 1120 to 3626 to 4843 to 684.8 to 7.0
    <30
        white male0 to 00 to 00 to 00 to 0.10 to 1.30.2 to 3.50.5 to 2.20.1 to 0.3
        white female0 to 00 to 0.10 to 00 to 00.1 to 1.50 to 1.62.0 to 5.70.1 to 0.5
        black male0 to 00 to 0.70 to 00 to 1.90 to 2.50 to 3.30 to 00 to 0.5
        black female0 to 0.40 to 1.00 to 1.40 to 00.1 to 2.70 to 01.9 to 150.2 to 0.8
    • View popup
    Table 4.

    Relationship between MDRD GFR and Cockcroft-Gault (CG) creatinine clearance in white and black participantsa

    MDRD GFR(ml/min per 1.73 m2)CG CrCl (ml/min)
    White ParticipantsBlack Participants
    <3030 to 5960 to 79≥80<300 to 5960 to 79≥80
    a The number of participants and the percentages that would be classified into the same clearance category by both estimating equations are shown in bold. Numbers and percentages for noncongruent results (i.e., participants who would be categorized differently by the two formulae) are also shown. n represents the actual number of participants in each cell (i.e., unweighted data), whereas percentages are derived from weighted analyses. MDRD GFR estimated according to MDRD Equation 7. CG CrCl Cockcroft-Gault creatinine clearance.
    <30
        n316141
        % within MDRD GFR category7426955.1
        % within CG CrCl category230.5370.2
    30 to 59
        n1401082319112271742913
        % within MDRD GFR category4.45627131169146.7
        % within CG CrCl category7454152.953352.90.5
    60 to 79
        n11790144017615237403433
        % within MDRD GFR category<0.11335530.4183844
        % within CG CrCl category2.943674210494418
    ≥80
        n564523231794771928
        % within MDRD GFR category0.912872.51880
        % within CG CrCl category2.51856175482
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Journal of the American Society of Nephrology: 13 (5)
Journal of the American Society of Nephrology
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1 May 2002
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Prevalence of Low Glomerular Filtration Rate in Nondiabetic Americans: Third National Health and Nutrition Examination Survey (NHANES III)
Catherine M. Clase, Amit X. Garg, Bryce A. Kiberd
JASN May 2002, 13 (5) 1338-1349; DOI: 10.1097/01.ASN.0000013291.78621.26

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Prevalence of Low Glomerular Filtration Rate in Nondiabetic Americans: Third National Health and Nutrition Examination Survey (NHANES III)
Catherine M. Clase, Amit X. Garg, Bryce A. Kiberd
JASN May 2002, 13 (5) 1338-1349; DOI: 10.1097/01.ASN.0000013291.78621.26
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