KEEP

About KEEP

WHAT IS THE KIDNEY EARLY EVALUATION PROGRAM (KEEP)?

KEEP is a free health screening program offered by the National Kidney Foundation (NKF) for individuals at increased risk of developing kidney disease.

WHAT ARE THE GOALS OF THE PROGRAM?
The goals of KEEP are to:

• Raise awareness about kidney disease especially among “high risk” individuals
• Provide free testing for people at increased risk for kidney disease
• Encourage people “at risk” to visit a clinician and follow the treatment plan recommended
• Provide educational information so that “at risk” individuals can prevent or delay kidney damage
• Provide clinician referrals for follow-up care, if needed
• Provide ongoing information and support

WHO SHOULD ATTEND A KEEP SCREENING?
You should attend a KEEP screening if you are 18 years or older and have one or more of the following:

• Diabetes
• High blood pressure
• A parent, brother or sister with diabetes, high blood pressure or kidney disease

Please do not register for KEEP more than once a year. KEEP is only a screening service and not meant to provide a diagnosis or replace regular visits with your healthcare provider.

WHAT TAKES PLACE AT THE SCREENING?
One or more of these services will be provided to you at the screening:

• Blood pressure, height, weight and waist circumference measurements
• Blood and urine tests for signs of diabetes and kidney disease, including
  • Blood glucose check blood sugar
  • Hemoglobin check blood test for anemia
  • Albumin to creatinine ratio (protein in urine)
  • Serum creatinine (measures how well kidneys are filtering blood)
  • Estimated Glomerular Filtration Rate (test for kidney function)
  • Total cholesterol, HDL, LDL and triglycerides
  • Some participants will also have their calcium, phosphorus, PTH and/or Hemoglobin A1c drawn

Test results are provided on site by a clinician.
Free educational materials are also available.

WHAT HAPPENS AFTER THE SCREENING?
The National Kidney Foundation will:

• Contact you with your results
• With your permission, send your results to your clinician
• Refer you to a clinician or public health facility, if needed
• Provide additional information, education and support
• Invite you back to attend a KEEP screening every year

HOW CAN I PARTICIPATE?

To obtain more information on KEEP and for a listing of Kidney Early Evaluation Programs (KEEP) taking place in your area, call the National Kidney Foundation at 1-800-622-9010.

Understanding test values

Blood pressure, glucose (diabetes), a urine test for albumin (protein), height, weight and waist circumference are measured and the results are available to you the day of the screening. If you qualify to complete the entire screening, the following blood tests will be measured and sent to a lab: creatinine (kidney disease), lipids (HDL, LDL and triglycerides), hemoglobin (anemia) and GFR (kidney function). Individuals with an eGFR below 60 will have a calcium, phosphorus, and PTH conducted by the lab to assess bone health. Any participant with self-reported diabetes or blood sugar levels indicative of diabetes will have a Hemoglobin A1c done by the lab. You will receive your results in the mail in about four weeks.

1. Blood Pressure: Blood pressure is the force your blood puts on the walls of your blood vessels as your heart works. Uncontrolled high blood pressure can cause heart disease, stroke, kidney disease and damage to the blood vessels. The guidelines presented in the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VII) are used in the KEEP program for classification of values and referral guidelines. The JNC VII classifications for adults 18 years and older are defined below.

The classification of prehypertension was created to increase the awareness of the possibility of developing hypertension so that measures, such as adopting a healthy lifestyle, can be taken to prevent high blood pressure.




Understanding Blood Pressure Reading

Systolic

Upper number (systolic) is less than 120 mm Hg ......... Normal

Upper number (systolic) is 120 - 139 mm Hg ......... Pre hypertension

Upper number (systolic) is 140 - 159 mm Hg ......... Hypertension (stage 1)

Upper number (systolic) is 160 mm Hg or greater ......... Hypertension (stage 2)


Diastolic

Lower number (diastolic) is less than 80 mm Hg ......... Normal

Lower number (diastolic) is 80 - 89 mm Hg ......... Pre hypertension

Lower number (diastolic) is 90 - 99 mm Hg ......... Hypertension (stage 1)

Lower number (diastolic) is 100 mm Hg or greater ......... Hypertension (stage 2)




If you have diabetes and/or kidney disease, the target range for the upper number (systolic) is less than 130 mm Hg and the lower number (diastolic) is less than 80 mm Hg.

2. Blood Glucose Check: Blood glucose is the concentration of sugar in the blood. This test is done to check for diabetes. A drop of blood placed on a glucose monitor is used to determine your glucose value. Glucose is the sugar in your blood.



Understanding Blood Glucose Reading

No known Diabetes	Known Diabetes
Fasting (Before eating) <40 Low 40-99 mg/dl    Normal 100-125 mg/dl     Impaired Fasting Glucose More than 125 mg/dl   Indicates diabetes Non-Fasting (After eating) <40 Low 40-139 mg/dl    Normal 140-199 mg/dl            High 200 mg/dl and higher  Indicates diabetes	Fasting (Before eating) Less than 70 mg/dl     Below target range 70 - 130 mg/dl           Within target range More than 130 mg/dl  Above target range Non-Fasting (After eating) <40 Low Less than 180 mg/dl   Within target range 180 mg/dl    and higher Above target range




3. Albumin to creatinine ratio: The albumin to creatinine measurement estimates the amount of protein (albumin) found in your urine in a day and avoids the need to collect a 24-hour urine specimen. This test also helps measure for protein in the urine more accurately, since it corrects for differences in urine concentration.



Less than 30 mg/gm          Normal

30 mg/gm or Greater         Abnormal

Results for the following tests will be mailed to you within a few weeks.

• Hemoglobin: A hemoglobin test is done to determine anemia or low red blood cell count. There are many reasons why the hemoglobin level can be low. Individuals with advanced kidney disease and poor kidney function can develop anemia.




Female:   11.7-15.5 gm / dl-Normal                <11.7 gm / dl-Low

Male:     13.2-17.1 gm / dl-Normal               <13.2-Low



• Lipid Panel

This test is used to evaluate your risk of heart disease and includes the measurement of cholesterol and triglycerides.

Total Cholesterol

Less than 200 mg/dl - Normal
200 mg/dl and higher - Elevated

HDL Cholesterol:
Less than 40 mg/dl - Undesirable
40 mg/dl and higher - Desirable

LDL Cholesterol:
Less than 100 mg/dl - Optimal
100-129 mg/dl- Near Optimal/Above Optimal
130 mg/dl and higher - Elevated

Triglycerides:

Less than 150 mg/dl - Normal
150 mg/dl and higher - Elevated

• Estimated Glomerular Filtration Rate (eGFR): This test is used to get a better estimate of your kidney function. Your serum creatinine, age, race and gender are needed so we can provide this measurement to you.



≥60 ml / min / 1.73 m²         Normal

<60 ml / min / 1.73 m²         Abnormal

• Calcium, Phosphorus, PTH

Calcium, Phosphorus and PTH tests are being conducted to assess bone health, which may be related to kidney disease and/or other problems. The following blood tests will be done in an eGFR below 60 only.

1. Calcium - tests for levels of calcium in the blood
2. Phosphorus - tests for levels of phosphorus in the blood
3. PTH - test for levels of parathyroid hormone in the blood
• Hemoglobin A1c (HbA1c)

This test will only be done on participants with self reported diabetes or blood sugar levels that indicate diabetes. Hemoglobin A1c evaluates blood glucose levels over a 6-8 week period.

Hemoglobin A1c:
≤ 7% - Normal
>7% - High