Coresh et al.20 estimated the population several times, with refinements in assumptions and in the estimating equations used to define estimated glomerular filtration rate (eGFR), most recently with an improved equation21 that corrects for underestimated eGFR more than 60 mL/min per 1.73 m2. The newest estimates place the CKD population at 11% of

the general population, versus 13% based on the older Modification of Diet in Renal Disease (MDRD) estimating equation.20 Of note, the CKD-EPI equation21 reduces bias in underestimating GFR more than 60 mL/min per 1.73 m2 compared with the MDRD estimating equation.20 The CKD-EPI equation should be considered for implementation in screening programs; it will reduce the number of false positives and selleck chemicals llc improve the accuracy of testing for kidney disease. Whether the estimate is 26 million people or the newer 21 million people, the size of this population is substantial. Almost a million C646 people are at stage 4 CKD; they are just one stage from entering the ESRD incident population, but are far more likely to die before developing ESRD. These estimates are consistent around the world, as reports from China,7 Japan,22 Australia10 and the Democratic Republic of the Congo12 give estimates of 10–14% of the population having evidence of

CKD using methods similar to methods used by Coresh et al.20 and Levey et al.21 The future number of potential ESRD patients is considerable unless contravening measures limit progression and the competing event of death reduces the number of CKD patients who reach ESRD. Because major public

health programs have been focused on reducing death rates from major diseases, efforts to slow progression of kidney disease will be needed – along with longer-term lifestyle changes – to reduce the at-risk population with diabetes and hypertension. Several reports have shown that hypertension, diabetes and cardiovascular disease increase with decreasing eGFR (Fig. 2). Similar findings were reported in the Taiwanese population studied for evidence of CKD.15 A similar pattern is noted when kidney damage is defined by increasing albumin-to-creatinine ratio (Fig. 3). This level of comorbidity Levetiracetam is associated with increasing cardiovascular event rates and mortality with advancing CKD stage,14,15 providing evidence that the highest rates of complications in the CKD population occur for patients with evidence of diabetes and cardiovascular disease. The observation of low recognition of CKD (12% of the population in Taiwan show evidence of CKD, but only 3% of patients with evidence of CKD were aware of it) demonstrates the challenge of engaging people in proactively seeking care and adhering to medical therapy to reduce the risk of future adverse events, premature death and progression to ESRD. In the study by Go et al.