1. The National Kidney Foundation’s Kidney Early Evaluation Program TM “The Greater New York Experience” Ellen H. Yoshiuchi, MPS Division Program Director National Kidney Foundation Serving Greater New York

2. Kidney Early Evaluation Program TM www.keeponline.org

3. KEEP Objectives KEEP Objectives Identify those at  risk for Chronic Kidney Disease (CKD) using inclusion criteria: –Hypertension –Diabetes –Family history in first order relatives of hypertension, diabetes or chronic kidney disease To empower individuals to prevent or delay the onset of CKD or renal failure through education and appropriate disease management

4. Chronic Kidney Disease Is a Public Health Problem! 26 million Americans have CKD. Most don’t know it. The devastating consequences of CKD are End Stage Renal Disease (ESRD), which requires dialysis or transplantation, or cardiovascular disease & death. Early screening, diagnosis, and treatment should delay or prevent death and ESRD. CKD is a worldwide public health problem.

5. New York State Impact An estimated 1.2 million New Yorkers are affected by CKD. The Center for Disease Control (CDC) reports a 116% increase in CKD in NYS over the past decade. In cost related to CKD, NYS is the 4th highest state at $2.9 billion. 7,300 New Yorkers will advance to End Stage Renal Disease (ESRD) annually. The diabetic CKD prevalence rate has increased from 6.2% to 7.6% from 2000 to 2006. Primary Causes of ESRD –Diabetes 40.5% –Hypertension 24%

6. KEEP OVERVIEW KEEP is a free public health screening program. It was initiated in New York City by the National Kidney Foundation in August of 2000. Screenings are held in all areas of the US by local National Kidney Foundation divisions or affiliates. Over 160,000 people have been screened to date. Visit www.KEEPonline.org for more information.www.KEEPonline.org

7. Who Should Participate In KEEP? Anyone age 18 or older with one or more of the following: History of diabetes History of high blood pressure Family history in first order relatives of diabetes, high blood pressure and/or kidney disease. (KEEP is not recommended for anyone on dialysis or for anyone who has had a kidney transplant.)

9. Station One – Registration: Participant receives paperwork packet Station Two – Screening Questionnaire & Informed Consent: Filled out by a professional volunteer Station Three – Physical Measurements: Height, weight, waist circumference, BMI & blood pressure Station Four – Urine & Blood Testing Station Five – Clinician Consultation: Interview with a physician, nurse practitioner or physician assistant Station Six – Screening Review: Participants receive copy of informed consent & test results Six Screening Stations

10. KEEP Screening Evaluation  Medical history  DM  HTN  CVD  CKD  Blood pressure  Height and weight  Waist circumference  Body mass index (BMI)  Blood glucose measurement  Hemoglobin A1c (select participants)  Serum creatinine  Hemoglobin  Albumin to Creatinine ratio  eGFR-Estimated Glomerular Filtration Rate  Lipid testing  Total Cholesterol  HDL/LDL/Triglycerides  For eGFR<60 ml/min, Reflex Testing:  Calcium  Phosphorus  PTH-Parathyroid hormone

11. Estimated Glomerular Filtration Rate (eGFR) Calculated based on serum creatinine test result, age, gender and ethnicity. Determines kidney function. Results sent to participant within 4 weeks, with a comprehensive report.

12. Blood Test: Hemoglobin Used to determine anemia, which can be due to advanced Stages 3 to 5 or even low levels of kidney function. KDOQI Classification of Anemia in CKD Women<12.0 g/dlAnemia Men<13.5 g/dlAnemia AJKD May 2006

13. Reflex Tests The following tests are conducted on the blood specimens of KEEP participants with an eGFR below 60: Calcium Phosphorus PTH These tests assess bone health. Abnormal results may be related to kidney disease.

14. KEEP CRITERIA FOR HEMOGLOBIN A1c History of Diabetes Fasting blood glucose of > 126 mg/dl Non-fasting blood glucose of > 200 mg/dl

15. Stages of CKD StageDescriptionGFR (ml/min/1.73 2 ) 1GFR Kidney damage and normal or  GFR  90 2Kidney damage and Mild  GFR 60-89 3 Moderate  GFR 30-59 4 Severe  GFR 15-29 5Kidney Failure usually need dialysis <15

16. KEEP in Greater New York 5 Years/62 Screenings 2/1/2004 to 6/30/2009 4,944 attended the screenings. 4,356 met inclusion criteria & completed the screening. Breakdown by gender Male: 33.54% (1461) Female: 66.21% (2884)

17. Of the 4,356 who learned of a new problem… 2,538 learned they may have kidney disease:58.26% 465 learned they may have diabetes: 10.67% 555 learned they may have hypertension: 12.74% 855 learned they may have high cholesterol: 19.63%

18. Of the 847 individuals who reported values for all 9 tests… Values outside the normal range: 23.14%--1 value 25.27%--2 values 20.54%--3 values 9.45%--4 values 78% of the 847 showed values outside the normal range in 1 to 4 values.

19. All Asian 1,276 participants 1,056 met criteria 399 male 656 female 1 NA Asian 96% Caucasian & African American 4%

20. All Chinese: 95% Chinese 800 participants/702 met criteria 252 Male: 35.90% 449 Female: 63.96% Individuals who were aware of a pre- existing condition: 50—kidney disease: 7.12% 230—high cholesterol:32.76% 147—diabetes: 20.94% 282—hypertension:40.17%

21. Individuals who learned that they may have a new problem… Diabetes 13.82% (97) HTN 10.68% (75) Cholesterol 18.66% (131) CKD 58.83% (413)

22. Of the 103 individuals who reported values for all 9 tests… Values outside the normal range: 24 individuals23.30%--1 value 27 individuals26.21%--2 values 17 individuals16.50%--3 values 6 individuals 5.83%--4 values 2 individuals 1.94%--5 values 4 individuals 3.88%--6 values

23. Values Outside the Norm 80 individuals out of 103… reported one of more values outside the normal range 12 reported with 4 to 6 values outside the normal range