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February 13, 2008

Determining Prevalence of Chronic Kidney Disease Using Estimated Glomerular Filtration Rate

JAMA. 2008;299(6):631-632. doi:10.1001/jama.299.6.631-a

To the Editor: Using data from the National Health and Nutrition Examination Surveys (NHANES 1988-1994 and NHANES 1999-2004), Dr Coresh and colleagues1 documented an increasing prevalence of chronic kidney disease (CKD) in the United States related in part to increasing prevalence of hypertension and diabetes. However, we have some concern about the absolute percentage of patients with stage 3 CKD, defined as estimated glomerular filtration rate (GFR) between 30 and 59 mL/min/1.73 m2. In the NHANES 1999-2004 study, the prevalence of CKD stage 3 was high (7.69%), implying that 15.5 million US individuals have GFR below 60 mL/min/1.73 m2. There are 3 reasons these figures could be overestimated, due to the use of the Modification of Diet in Renal Disease (MDRD) Study formula with a resultant systematic GFR underestimation.