NKF’s Kidney Early Evaluation Program Expands


The National Kidney Foundation’s (NKF) Kidney Early Evaluation Program (KEEP) provides comprehensive health risk appraisals to assess kidney function and key risk factors for chronic kidney disease (CKD), including hypertension and diabetes. Since 1997, this rapidly expanding program has screened more than 125,000 individuals. About 20,000 people were screened in 2008 alone.

The approximately 26 million American adults with CKD comprise a population with significant co-morbidities associated with diabetes and hypertension. Unfortunately, the cumulative effects of these co-morbidities—including secondary hyperparathyroidism, anemia, and cardiovascular disease—have been found to heighten awareness of CKD at later stages (stages 3–5), when it may be too late for preventive programs such as KEEP to be useful. These findings will be highlighted at this month’s NKF Spring Clinical Meetings in Nashville, Tenn., and will be published in the American Journal of Kidney Diseases.

“Most of the 26 million adults who are living with CKD in the United States are not even aware that they have it. In fact, our data show that less than 10 percent of KEEP participants with evidence of CKD were aware of the disease,” said Joseph Vassalotti, MD, chief medical officer at NKF. “Early-stage CKD can be difficult to diagnose because symptoms are not usually apparent until the disease progresses to near kidney failure. Yet research shows that treating kidney disease earlier may help improve outcomes.”

To gauge KEEP’s effectiveness at eliciting patient action upon learning of their health status, 72,000 participants in KEEP events were mailed a follow-up questionnaire. Nearly 30 percent responded. Seventy-one percent of those who responded said they saw a physician within three months of participating in KEEP. Participants were more likely to see a physician if they were diagnosed with CKD, and the tendency to follow up with a doctor increased as kidney function declined.

Data from KEEP suggest that hypertension, diabetes, and cardiovascular disease are more prevalent in the CKD population than in the general population and that early identification is associated with improved follow-up. Individuals diagnosed with such life-threatening conditions were more likely to pay a visit to their doctors after participating in KEEP.

Among those diagnosed with hypertension, 50 percent started monitoring their blood pressure and taking prescription medication, and nearly 17 percent adjusted their diets within three months of participating in KEEP. Among those who learned they had diabetes through their participation in KEEP, 34 percent adjusted their diets, 40 percent began taking prescription medication, and 50 percent began monitoring the levels of glucose in their blood.

“These findings show that efforts to screen people at risk for disease can boost communitywide health,” said Allan J. Collins, MD, director of KEEP’s data coordinating center and immediate past president of NKF. “Once people learn they are at risk or already have kidney disease, high blood pressure, or other deadly diseases, they will go to the doctor and take the medications they need to survive. Simply put, these findings show that community screening programs such as KEEP do work as a wake-up call to participants.”

Peter McCullough, MD, a cardiologist and vice chair of the KEEP Program, was quoted on National Public Radio in 2007: “Most people know their cholesterol numbers but are completely unaware of their kidney function or microalbumin (kidney damage indicator) results. Furthermore, most individuals are caught by surprise when they learn that a subtle decrease in kidney function can contribute to heart disease.”

In 2008, KEEP launched a longitudinal component to strengthen and broaden its programs. The new patient follow-up initiative has two primary objectives: first, to assess past participants for improvements in health outcomes, and, second, to arm community health-care providers with outcomes data based on patients’ ongoing results from the KEEP follow-up.

KEEP is also expanding its activities beyond comprehensive kidney screenings to increase the program’s impact on national health initiatives such as those for obesity and diabetes. This initiative will extend KEEP screenings into new geographic regions, with a focus on areas with large populations of at-risk individuals, including minorities, who have a higher incidence of the disease. Public awareness activities at individual KEEP screenings will be enhanced.

“KEEP is the preeminent screening program for CKD that is helping unite the medical community, state and federal governments, and advocacy groups around addressing the increasing prevalence of CKD, particularly within minority communities where the need is greatest,” said Preston Klassen, executive director of global nephrology development at Amgen.

According to U.S. Rep. Mark Kirk (R-Ill.), co-chair of the Congressional Kidney Caucus, “Early detection and increased awareness of chronic kidney disease and its causes are essential to helping stem the growing prevalence of the disease that we’ve seen in recent years. KEEP plays a key role in helping us reach that goal.”

The KEEP Program stands as an excellent example of a medical society working through local affiliates to improve community health through screening and detection. KEEP builds improved awareness and knowledge about this very common form of disease.

NKF Offers Free Screening, Education on World Kidney Day


In recognition of the worldwide significance of kidney disease as a public health problem, the 4th annual World Kidney Day is March 12, 2009. The National Kidney Foundation will lead U.S. activities for World Kidney Day designed to build kidney disease awareness and to educate those at risk about the importance of early detection and the critical role the kidneys play in maintaining overall health.

To make early detection of chronic kidney disease as easy as possible, the foundation is offering more than 50 free kidney screenings through KEEP around the United States on World Kidney Day and throughout the month of March.

For locations and schedules, visit www.keeponline.org.

Disclosures: Funding for KEEP is provided by Amgen, Abbott Renal Care, Genzyme, Novartis, and Genentech. Additional support is provided by Lifescan, OceanSpray, and Suplena.

Acknowledgments: Peter McCullough, MD, consultant cardiologist and chief of the division of nutrition and preventive medicine at William Beaumont Hospital in Royal Oak, Mich., and George L. Bakris, MD, FASN, of the University of Chicago Pritzer School of Medicine, contributed to this article.