Screening Populations at Increased Risk of CKD: The Kidney Early Evaluation Program (KEEP) and the Public Health Problem

The epidemiological characteristics of the US end-stage renal disease population growth and increased costs in the late 1980s framed the public health agenda for the development of a community-based chronic kidney disease (CKD) screening program. Development of the National Kidney Foundation Kidney Early Evaluation Program (KEEP) included 2 preliminary screening programs, the Computerized Assessment of Risk and Education and the KEEP pilot, which was organized around the African American Study of Kidney Diseases clinical centers. The current KEEP program, launched in August 2000, targets individuals with diabetes, hypertension, or a family history of diabetes or hypertension or CKD. The screening includes informed consent, health screening questionnaire, diagnostic panel, and physician consultation. Participants are followed up by telephone and mail. Of 100,000 KEEP participants screened, 28.7% have CKD and 6.7% self-reported CKD stages 1 to 5. Conversely, National Health and Nutrition Examination Survey 1999-2002 results show 13.1% CKD prevalence; 2.9% of women and 17.9% of men with an estimated glomerular filtration rate less than 60 mL/min/1.73 m2 self-report CKD. CKD prevalences in KEEP by stage are 3.1% for stage 1; 4.8%, stage 2; 19.7%, stage 3; and 1.1%, stages 4 and 5, confirming the ability of this targeted screening program to detect CKD early. In addition to identifying individuals at increased risk of kidney disease, KEEP's structured data collection provides an opportunity to advance knowledge about kidney disease and advance the CKD public health agenda.