Cardiovascular risk factor profiles and kidney function stage in the US general population: The NHANES III study

OBJECTIVE: To determine the prevalence of cardiovascular risk factors in the general population based on kidney function. SUBJECTS AND METHODS: We retrospectively analyzed data from the Third National Health and Nutrition Examination Survey of noninstitutionalized US adults, which was conducted from 1988 to 1994. Data were gathered on 9 cardiovascular risk factors (smoking; obesity; hypertension; high total cholesterol, C-reactive protein, glycosylated hemoglobin, and homocysteine levels; low hemoglobin level; and high urinary album In-to-creatinine ratio) and estimated glomerular filtration rate (GFR). RESULTS: For the 15,837 subjects, the estimated GFR was at least 90 mL/min per 1.73 m(2) (normal) in 65.4%, 60 to 89.9 mL/ min per 1.73 m(2) (stage 2 kidney function) in 27.9%, 30 to 59.9 mL/min per 1.73 m(2) (stage 3 kidney function) in 6.2%, and less than 30 mL/min per 1.73 m(2) (stages 4 and 5 kidney function) in 0.5%. The number of cardiovascular risk factors Increased with stage of kidney dysfunction. Of subjects with a normal GFR, 30.4% had no risk factors, 34.9% had 1 risk factor, and 34.7% had 2 or more risk factors. Of subjects with stage 2 kidney function, 24.8% had no risk factors, 30.3% had 1 risk factor, and 44.9% had 2 or more risk factors. Of subjects with stage 3 kidney function, 1.4% had no risk factors, 14.9% had 1 risk factor, and 83.6% had 2 or more risk factors. All subjects with stages 4 and 5 kidney function had 2 or more risk factors. After covariate adjustment, odds ratios for having an estimated GFR lower than 60 mL/min per 1.73 m(2) were 1, 3.7 (95% confidence interval, 1.2-11.3), and 10.4 (95% confidence interval, 3.9-27.8) times greater in subjects with 0, 1, and 2 or more cardiovascular risk factors, respectively (P <=.001). CONCLUSION: Persons with chronic kidney disease are much more likely to need multiple cardiovascular risk factor interventions than those without chronic kidney disease.