To improve cardiovascular care in people with CKD, Healthy People 2020 objective 6b aims to reduce the proportion of people with CKD who have elevated lipid levels. CKD is accompanied by characteristic abnormalities of lipid metabolism, which are reflected in an altered apolipoprotein profile as well as elevated plasma lipid levels. Dyslipidemia is a major risk for cardiovascular morbidity and mortality in patients with CKD. In 2005-2010, the percentage of adults with CKD with elevated lipid levels (defined as abnormal lipid values or the use of cholesterol-lowering medication) was 19.9%; higher than the 19.1% in 1999-2004, at baseline.
Chart Explanation: At baseline, 20.8% of men had elevated lipid levels compared to 17.6% of women. However, the percent with elevated lipid levels increased to 19.2% for women in the current period while remaining constant for men. The percentage with elevated lipid levels increased from baseline for ages 25-64 and declined for those aged 65 and older. Elevated lipid levels increased among whites and remained constant for Hispanics, while decreasing by 5.4% of baseline for African Americans.
The NHANES (National Health and Nutrition Examination Survey) is a nationally representative, cross-sectional survey that is currently conducted every 2 years by the National Center for Health Statistics to examine disease prevalence and trends over time in non-institutionalized U.S. civilian residents.
The survey consists of a standardized in-home interview and a physical examination and blood and urine collection at a mobile examination center (MEC). Here, we examined data from the 1999-2000, 2001-2002, 2003-2004, 2005-2006, 2007-2008, and 2009-2010 NHANES, in addition to data from NHANES III (1988-1994). eGFR was calculated according to the modified MDRD study formula for calibrated creatinine (Levey et al., 2005; Levey et al., 2006). Serum creatinine was calibrated for 1999-2000 and 2005-2006 participants; no correction was required for calibrated serum creatinine in participants in the 2001-2002, 2003-2004, 2007-2008, and 2009-2010 surveys (Selvin et al., 2007). Albuminuria was defined by urinary albumin-to-creatinine ratios of 30-299 mg/g (microalbuminuria) and >300 mg/g (macroalbuminuria); pregnant women were excluded. For comparisons across the 12-year period 1999-2010, albuminuria was corrected in 1999-2006 to account for differences in the instrumentation and method for urine creatinine starting in 2007. Prevalence of CKD is likely overestimated due to single measurements of albuminuria and kidney function, since chronic disease is defined as having albuminuria ror reduced kidney function for ≥3 months.
| Field | Data |
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| Description of Measure | Percent of persons with chronic kidney disease who have hyperlipidemia |
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| Data Source | NCHS |
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| Type of Data Source | Public |
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| Data Set | NHANES |
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| Health Care System Data | No |
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| Regional or National? | National |
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| Demographic Group | Non-institutionalized adults 18+ years with CKD. |
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| Numerator | Number of adults 18 years or older with chronic kidney disease (CKD) stages 1-4 with abnormal lipid values, or reported prescription for statins . Abnormal lipid values defined by ATP III guidelines [1] (all values in mg/dl). |
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| Denominator | All those with CKD stages 1-4 who answered the awareness question. |
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| Definition of CKD | Stage 1, eGFR ≥ 90 ml/min/1.73 m² and estimated persistent albuminuria; Stage 2, eGFR 60-89 ml/min/1.73 m² and estimated persistent albuminuria; Stage 3, eGFR 30-59 ml/min/1.73 m²; Stage 4, 15-29 ml/min/1.73 m²; Stage 5, excluded |
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| Definitions | Educational attainment data was collected only for subjects 25 years and over; health insurance status is limited to individuals under 65 years of age in order to exclude potential Medicare patients; family income was calculated as a percent of the Federal Poverty Limit. |
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| Glomerular filtration rate | Estimated using MDRD study formula for calibrated creatinine: eGFR=175 × [(calibrated serum creatinine in mg/dl)-1.154] × age-0.203 × (0.742 if female) × (1.210 if African-American) |
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| Proteinuria | Urinary albumin-to-creatinine ratios of 30-299 mg/g (microalbuminuria) and >300 mg/g (macroalbuminuria); pregnant/menstruating women excluded |
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| Primary Data Source Indicator | lbxscr: Serum creatinine |
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| Primary Indicator Method of Measurement | Examination/Laboratory |
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| Secondary (1) Variable | ridageyr: Age in years |
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| Secondary (1) Indicator Method of Measurement | Questionnaire (interviewer-administered) |
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| Secondary (2) Variable | ridgendr: Gender |
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| Secondary (2) Indicator Method of Measurement | Questionnaire (interviewer-administered) |
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| Secondary (3) Variable | No |
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| Secondary (3) Indicator Method of Measurement | ridreth1: Race/ethnicity |
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| Secondary (3) from Medical Record? | Questionnaire (interviewer-administered) |
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| Secondary (4) Data Source Indicator | urxuma: Urine albumin |
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| Secondary (4) Indicator Method of Measurement | Examination/lab |
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| Secondary (5) Data Source Indicator | urxucr: Urine creatinine |
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| Secondary (5) Indicator Method of Measurement | Examination/lab |
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| Frequency of Measurement (Primary) | Once (cross-sectional) |
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| U.S. Region Covered by Primary Variable | All |
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| Period Currently Available | 1999–2020 |
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| Pending Data | 2011-2016 |
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| Additional Data Items of Interest | Stage of CKD, year, other stratification variables of interest (diabetes by self-report, hypertension by self-report) |
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| Limitations of Indicator | Albuminuria and kidney function can only be assessed from a one-time cross-sectional measurement, leading to overestimation of prevalence; second measures of albuminuria are available for only 2009-2010 and were first-morning rather than spot urine samples; no second measures of creatinine |
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| Analytic Considerations | Appropriate NHANES survey weights must be used for all analyses; creatinine measurements must be calibrated for NHANES III, 1999-2000 and 2005-2006; many variable names differ across surveys; if SE 30% or more of estimate, must report as "low precision" |
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| References | 1. Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). National Cholesterol Education Program. National Heart, Lung, and Blood Institute National Institutes of Health NIH Publication No. 02-5215 September 2002. |
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