{'fraction_non_alphanumeric': 0.03220478943022296, 'fraction_numerical': 0.018166804293971925, 'mean_word_length': 4.824519230769231, 'pattern_counts': {'":': 0, '<': 2, '<?xml version=': 0, '>': 2, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Chronic Kidney Disease: It's Time to Recognize Its Presence in Our Patients With Hypertension

VOL. VI NO. X OCTOBER 2004 548 Chronic kidney disease (CKD) is one of the world’s major public health problems, and the prevalence of kidney failure is rising steadily. CKD is defined in the Seventh report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure1 as either (1) an estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73 m2 or (2) the presence of clinical proteinuria (>300 mg/d or 200 mg/g creatinine). In the United States alone, 20 million Americans, or one in nine adults, have CKD and another 20 million more are at increased risk for its development.2 Hypertension is a significant risk factor for CKD. The early stages of CKD are primarily a silent disease. While blood pressure (BP) monitoring occurs at nearly every visit to the doctor, screening for CKD occurs infrequently. The failure to screen for CKD is a missed opportunity for improving patient outcome. How do we recognize CKD? There are two ways to detect this disease. 1. Measure for proteinuria (macroalbuminuria), which can be detected on initial urinalysis. Patients with hypertension should have a routine urinalysis.1 Increased urinary protein excretion is usually a marker of kidney damage and a predictor of disease progression.3 Testing for microalbuminuria is optional if no protein is detected on the initial dipstick, except for patients with diabetes where this should be a routine procedure.3 Microalbuminuria (>30 mg/d and <300 mg/d) is a risk factor for progressive kidney disease and a strong risk factor for cardiovascular (CV) disease,4 even in nondiabetic and nonhypertensive individuals.5 2. Determine the glomerular filtration rate (GFR). This step remains the most sensitive and specific means of assessing renal function in health and disease. While the GFR is most accurately determined by measurement of inulin clearance, this test is rarely done today because of its inherent complexity and cost. Instead, the serum creatinine is used to approximate the GFR. This measurement may overestimate GFR by 10%–40% in healthy persons and by a greater degree in people with CKD.3 Small changes in creatinine often represent large changes in the GFR. In using serum creatinine as a measure of the GFR, we sometimes fail to identify patients who have CKD (Table I).