Chronic vascular diseases constitute a growing global health problem. Objectives: To (a) determine marker positivity for renovascular damage in the total adult population of the Isle of Youth, Cuba; (b) describe marker association with common risk factors for renal and related chronic vascular conditions, and (c) identify best predictors of renovascular damage. Methods: Previous informed consent was obtained, the population studied was 55,646, and subjects were aged ≧20 years. Blood pressure, weight and height were measured and a questionnaire applied. Urine markers for renovascular damage (hematuria, proteinuria and microalbuminuria) were also determined. Results: Positive markers were detected in 21.3%: hematuria (12.6%), microalbuminuria (6.8%), proteinuria (0.9%), and proteinuria + hematuria (0.9%). Risk factors were highly prevalent: 15.1% were aged ≧60 years; 32.3% overweight, 13.9% obese, and 25.1% smokers. Prevalence of high blood pressure (30%), diabetes mellitus (5.4%) and cardiovascular disease (5%) was also high, while cerebrovascular disease registered 0.9%. Markers were more prevalent in older people and in those suffering from diabetes mellitus, high blood pressure, cardiovascular and cerebrovascular disease, overweight or obesity. Risk factor regression tree analysis identified hypertension as the best predictor of renovascular damage. Conclusions: Adult population-wide screening revealed hidden morbidity and permitted better risk stratification. Results serve to inform community-based multidisciplinary and intersectoral disease prevention and management.

Dirks JH, de Zeeuw D, Agarwal SK, et al: Prevention of chronic kidney disease and vascular disease: toward global health. The Bellagio 2004 Declaration. Kidney Int 2005;68:S1–S6.
Dirks JH, Robison SW, Alderman M, et al: Meeting Report on the Bellagio Conference. Prevention of vascular diseases in emerging world: an approach to global health equity. Kidney Int 2006;70:1397–1402.
Herrera R, Almaguer M, et al: Atención de la insuficiencia renal crónica por el sistema de salud de Cuba. En Primera Conferencia de Consenso. Insuficiencia renal crónica, diálisis y trasplante renal. Publicación Científica 520. Washington, OPS, 1989, pp 131–137.
Coresh J, Astor B, Greene T, et al: Prevalence of chronic kidney disease and decreased kidney function in the adult US population. Third National Health and Nutrition Examination Survey. Am J Kidney Dis 2003;1:1–12.
Centers for Disease Control and Prevention: Prevalence of chronic kidney disease and associated risk factors – United States, 1999–2004. MMWR Morb Mortal Wkly Rep 2007;56:161–165.
Hillege HL, Jaussen WMT, Bak AAA, et al: Microalbuminuria is common also in a nondiabetic, nonhypertensive population and an independent indicator of cardiovascular risk factors and cardiovascular morbidity. J Int Med 2001;249:519–526.
Almaguer López M, Herrera Valdés R, Chipi Cabrera J, et al: Design and methodology of the Isle of Youth community-based epidemiological study of CKD, cardio-cerebral vascular disease, hypertension, and diabetes mellitus (ISYS). MEDICC Rev 2007;9:23–30.
Gansevoort RT, Verhave JC, Hillege HL, et al: The validity of screening based on spot morning urine samples to detect subjects with microalbuminuria in the general population. Kidney Int 2005;67(suppl 94):S28–S35.
Iseki K, Ikemiya Y, Iseki C, et al: Proteinuria and the risk of developing end-stage renal disease. Kidney Int 2003;63:1468–1474.
Ramírez SP, I-Hong Hsu S, McClellan W: Taking a public health approach to the prevention of end-stage renal disease: The NKF Singapore Program. Kidney Int 2003;63 (suppl 83):S61–S65.
Li PK, Kwan BC, Leung CB, et al: Prevalence of silent kidney disease in Hong Kong: The Screening for Hong Kong Asymptomatic Renal Population and Evaluation (SHARE) Program. Kidney Int 2005;67(suppl 94):S36–S40.
Perico N, Plata R, Anabaya A, et al: Strategies for national health care systems in emerging countries: the case of screening and prevention of renal disease progression in Bolivia. Kidney Int 2005;68(suppl 97):S87–S94.
Stidley CA, Shah VO, Scavini M, et al: The Zuni Kidney Project: a collaborative approach to an epidemic of kidney disease. J Am Soc Nephrol 2003;14(suppl 2):S139–S143.
Yamagata K, Yamagata Y, Kobayashi M, et al: A long-term follow-up study of asymptomatic hematuria and/or proteinuria in adults. Clin Nephrol 1996;45:281–288.
Nieuwhof C, Doorenbos C, Grave W, et al: A prospective study of the natural history of idiopathic non-proteinuric hematuria. Kidney Int 1996;49:222–225.
Remuzzi G, Weening JJ: Albuminuria as early test for vascular disease. Lancet 2005;365: 556–557.
Pontremoli R, Leoncini G, Viazzi F, et al: Role of microalbuminuria in the assessment of cardiovascular risk in essential hypertension. J Am Soc Nephrol 2005;16(suppl 1): S39–S41.
Krimholtz MJ, Karalliedde J, Thomas S, et al: Albumin excretion rate in the treatment of the hypertensive diabetic patient with renal disease. J Am Soc Nephrol 2005;16(suppl 1): S42–S47.
Jong PE, Brenner BM: From secondary to primary prevention of progressive renal disease: the case for screening for albuminuria. Kidney Int 2004;66:2109–2118.
Bello AK, Nwankwo E, El Nahas AM: Prevention of chronic kidney disease: a global challenge. Kidney Int 2005;68(suppl 98):S11–S17.
Hillege HL, Fidler V, Diercks G, et al: Urinary albumin excretion predicts cardiovascular and noncardiovascular mortality in general population. Circulation 2002;106:9037–9038.
Rosas M, Attie F, Pastelin G, et al: Prevalence of proteinuria in Mexico: a conjunctive consolidation approach with other cardiovascular risk factors. The Mexican Health Survey 2000. Kidney Int 2005;68(suppl 97):S112–S119.
Iseki K: Screening for renal disease – what can be learned from the Okinawa experience. Nephrol Dial Transplant 2006;21:839–843.
Xue JL, Ma JZ, Louis TA, et al: Forecast of the number of patients with end-stage renal disease in the United States to the Year 2010. J Am Soc Nephrol 2001;12:2753–2758.
Locatelli F, Pozzoni P: Chronic kidney disease in the elderly: is it really a premise for overwhelming renal failure? Kidney Int 2006;69:2118–2120.
Hamer RA, El Nahas AM: The burden of chronic kidney disease. BMJ 2006;332:563–564.
United States Renal Data System 2007 Annual Data Report. Am J Kidney Dis 2008;51(suppl 1):S17–S32.
Haroun MK, Jaar BG, Hoffman SC, et al: Risk factors for chronic kidney disease: a prospective study of 23,534 men and women in Washington County, Maryland. J Am Soc Nephrol 2003;14:2934–2941.
Hoy WE, Wang Z, Baker P, et al: Reduction in natural death and renal failure from a systematic screening and treatment program in an Australian Aboriginal community. Kidney Int 2003;63(suppl 83):S66–S73.
McDonald SP, Russ GR: Burden of end-stage renal disease among indigenous peoples in Australia and New Zealand. Kidney Int 2003;63(suppl 83):S123–S127.
Mani MK: Experience with a program for prevention of chronic renal failure in India. Kidney Int 2005;67(suppl 94):S75–S78.
Correa-Rotter R, Naicker S, Katz IJ, et al: Demographic and epidemiologic transition in the developing world: role of albuminuria in the early diagnosis and prevention of renal and cardiovascular disease. Kidney Int 2004;66(suppl 92):S32–S37.
Orth SR: Smoking – a renal risk factor. Nephron 2000;86:12–26.
Gambaro G, Verlato F, Budakovic A, et al: Renal impairment in renal cigarette smokers. J Am Soc Nephrol 1998;9:562–567.
Ordunez-Garcia P, Bernal Munoz JL, et al: Success in control of hypertension in a low-resource setting: the Cuban experience. J Hypertens 2006;24:845–849.
Ríos Burrows N, Li Y, Williams DE: Racial and ethnic differences in trends of end-stage renal disease: United States, 1995–2005. Adv Chronic Kidney Dis 2008;15:147–152.
Segura J, Campo C, Ruilope LM: Effect of proteinuria and glomerular filtration rate on cardiovascular risk in essential hypertension. Kidney Int 2004;66(suppl 92):S45–S49.
Batlle D: Clinical and cellular markers of diabetic nephropathy. Kidney Int 2003;63:2319–2330.
Sarnak MJ, Levey AS: Cardiovascular disease and chronic renal disease: a new paradigm. Am J Kidney Dis 2000;35(suppl 1): S117–S131.
Go AS, Chertow GM, Fan D, et al: Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004;351:296–305.
Ritz E, McClellan WM: Overview: increased cardiovascular risk in patients with minor renal dysfunction. An emerging issue with far-reaching consequences. J Am Soc Nephrol 2004;15:513–516.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.