Fractal regional myocardial blood flows pattern according to metabolism, not vascular anatomy.

Regional myocardial blood flows are markedly heterogeneous. Fractal analysis shows strong near-neighbor correlation. In experiments to distinguish control by vascular anatomy vs. local vasomotion, coronary flows were increased in open-chest dogs by stimulating myocardial metabolism (catecholamines + atropine) with and without adenosine. During control states mean left ventricular (LV) myocardial blood flows (microspheres) were 0.5-1 ml·g(-1)·min(-1) and increased to 2-3 ml·g(-1)·min(-1) with catecholamine infusion and to ∼4 ml·g(-1)·min(-1) with adenosine (Ado). Flow heterogeneity was similar in all states: relative dispersion (RD = SD/mean) was ∼25%, using LV pieces 0.1-0.2% of total. During catecholamine infusion local flows increased in proportion to the mean flows in 45% of the LV, "tracking" closely (increased proportionately to mean flow), while ∼40% trended toward the mean. Near-neighbor regional flows remained strongly spatially correlated, with fractal dimension D near 1.2 (Hurst coefficient 0.8). The spatial patterns remain similar at varied levels of metabolic stimulation inferring metabolic dominance. In contrast, adenosine vasodilation increased flows eightfold times control while destroying correlation with the control state. The Ado-induced spatial patterns differed from control but were self-consistent, inferring that with full vasodilation the relaxed arterial anatomy dominates the distribution. We conclude that vascular anatomy governs flow distributions during adenosine vasodilation but that metabolic vasoregulation dominates in normal physiological states.

The risk factors of low birth weight infants in the northern part of Thailand.

BACKGROUND: The incidence of low birth weight (LBW) in Chiang Mai University Hospital was high. OBJECTIVE: Determined the incidence and risk factors of low birth weight infants. MATERIAL AND METHOD: The present study included pregnant women between 1989 and 1990 who attended the antenatal clinics (ANC) having a gestational age less than or equal to 24 weeks. During that period, up to delivery, clinical and other potential data namely demographic and biomedical factors, maternal status, socioeconomic factors, and nutritional factors were included. The birth weight at birth less than 2,500 gm was considered LBW. RESULTS: Two thousand one hundred eighty four pregnant subjects who delivered live born and were still eligible, were used for analysis in the present study. The incidence of LBW was 9.2% (201/2,184). Women with body mass index (BMI) at first antenatal clinics (ANC) less than 18.5 Kg/m2 and weight gain during the second trimester less than 300 grams/week was the strongest independent risk factor for LBW (odds ratio 11.25, 95% confidence interval (CI) 5.77-21.94). The number of antenatal care less than 4, monilial vaginitis, the infestation of hookworm and strongyloides, and pregnancy-induced hypertension were independent risk factors (odds ratio 11.04, 3.14, 4.93 and 4.02 respectively). CONCLUSION: The present study showed that low initial BMI, low weight gain in the second trimester, and low attendance at ANC are associated to the occurrence of LBW. The development of a scoring system for detecting high-risk of LBW in pregnant women based on a combination of antenatal factors should be pursued.

Mortality-related factors in 1056 radioiodine-treated patients with well-differentiated thyroid cancer in southern Thailand.

BACKGROUND: Reported risk factors for death related to well differentiated thyroid cancer vary, possibly depending on the methods and geographical site of data collection. METHOD: To evaluate variables related to death in well-differentiated thyroid cancer (WDTC) in a population of southern Thailand, we retrospectively reviewed medical records of all those treated with radioactive iodine (I-131) at the Division of Nuclear Medicine from 1983 to 2002. We found 1056 subjects. Variables examined included present status of subjects (transfer, lost, died), cause of death (related and not related to WDTC), duration of follow-up since surgery, largest size of tumor (when available), gender, histology (follicular or papillary, with mixed included in papillary), age of surgery, and site of spread when treated. Survival from WDTC death utilized Kaplan-Meier and Cox regression analysis. RESULTS: The median follow-up was 7 years, while only 4 years elapsed from surgery for those who died. We did not know the status of 16% of the subjects despite attempts to contact them. Survival was not affected by age, gender, or maximum size of tumor. Age at surgery was significant only for the group older than 55 years, with a 10-year survival of 76%. The spread of the disease that affected survival can be localized to the aerodigestive tract (10-year survival of 65%) and metastases associated with bone fracture (10-year survival 34%), while other metastases (including asymptomatic bone metastases) exhibited a 10-year survival of 93%. Neither lymph node spread nor elevated Tg at maximum stimulation predicted survival. CONCLUSIONS: To better predict survival of WDTC, site of spread and degree of spread has to be specific.

Comparison of cardiovascular risk factors in five regions of Thailand: InterASIA data.

BACKGROUND: Age- and sex- standardized mortality rate of cardiovascular disease (CVD) was high in Bangkok and central Thailand in the year 2000. This may partially be related to differences in risk factors. OBJECTIVE: To compare prevalence of CVD risk factors among regions in Thailand in the same period. MATERIAL AND METHOD: From a survey in 2000 (InterASIA) which involved 5 regions in Thailand, conventional CVD risk factors were compared multivariate-wise among regions and subsequently aligned with CVD deaths obtained within similar regions from the registry. RESULTS: Bangkok and a central province had a higher prevalence of the following: hypertension, elevated body mass index, large waist circumference, elevated lipid associated with low density lipoprotein cholesterol and diabetes mellitus. The Northeast had a higher prevalence of smoking, low values of high density lipoprotein cholesterol and high triglyceride. CONCLUSION: Definite regional differences existed of CVD risks and death in Thailand in 2000. Some of the metabolic risk factors may be more important than smoking in the link with CVD death in Thailand

Factors related to in-hospital heart failure are very different for unstable angina and non-ST elevation myocardial infarction.

Non-ST-elevation myocardial infarction (NSTEMI) and unstable angina (UA) resulted in different degrees of damage to the heart muscle, and yet, when factors related to in-hospital outcomes were examined, these two subsets were often lumped together as non-STelevation acute coronary syndrome. Therefore, we investigated predictors of in-hospital heart failure (HF) in UA and NSTEMI separately. Factors related to HF (Killip > or = 2) were analyzed for NSTEMI and UA in a Thai Acute Coronary Syndrome (ACS) registry conducted in 17 institutions between 2002 and 2005. The registry comprised of 9373 single admissions age 65.1 +/- 12.3 years, 40.2% women, and 45.1% with HF. There were 3548 NSTEMI and 1989 UA with HF prevalence of 56.2% and 27.4%, respectively. Heart failure patients were older, more were women, sicker (as shown by more of those with shock, postcardiac arrest, and breathless on admission), more with diabetes mellitus (DM), received less intervention and medication, and showed higher total death (19.3% vs 5.3% for NSTEMI with and without HF; and correspondingly, 5.9% and 1.9% for UA). Independent predictors (at presentation) for the development of HF following NSTEMI or UA were age (not sex), breathlessness, and less prevalence of chest pain. However, shock and DM were risks only for NSTEMI but not UA. Heart failure was found to be a factor for in-hospital death for NSTEMI only, with odds ratio of 2.84 (confidence interval 2.11-3.82) and 3.23 (2.25-4.64) for total and cardiac deaths, respectively. Non-ST-elevation myocardial infarction and UA showed substantial differences in factors related to predictors for in-hospital outcome such that these should be examined separately.

An equation to explain variations in blood NT-proBNP in ambulatory cardiac subjects.

BACKGROUND: NT-proBNP is being used as a biomarker for prognosticating and delineating cardiac dysfunction. The cut-off value for deciding normal versus abnormal levels has always been a point of contention since it depends on the degree of dysfunction as well as other associated conditions often termed non-cardiac factors and parameters. Such association had not been formally presented. OBJECTIVE: To determine the direction and magnitude of effect of cardiac and non-cardiac parameters on NT-proBNP variability. MATERIAL AND METHOD: The present study included 78 cardiac ambulatory patients with a history of heart failure and/or low left ventricular ejection fraction. Their cardiac and non-cardiac parameters were recorded at the time of blood sampling for NT-proBNP. Multivariate linear regression analysis was used to correlate cardiac and non-cardiac parameters with NT-proBNP level and, from this, a predictive equation was derived. RESULTS: Log [NT-proBNP (pmol/l)] was 1.424 + 0.348 (for EF of 18-27) + 0.636 (for EF < 18) + 0.021 CTR - 0.002 SMW- 0.326 for female + 0.430 Cr - 0.010 BW [EF = LV ejectionfraction in %; CTR = cardio-thoracic ratio in %; SMW = 6-minute walking distance in meters; Cr = serum creatinine in mg/dl; BW = body weight in kg]. The adjusted R-square for this regression was 0.659. Omitting the non-cardiac variables (sex, Cr, BW) would decrease the adjusted R-square to 0.493. CONCLUSION: Cut-off value for NT-proBNP concentration in subjects without severe systolic heart failure has to account for these non-cardiac factors.

Gender and ethnic differences in cardiovascular risks in Songkhla province, Thailand: the interASIA-south.

The subset of data on southern Thai InterAsia study conducted in 2000 was revisited in order to document gender and ethnic breakdown of prevalence of risk factors for cardiovascular diseases (CVD). Three hundred and seventy-five men and 630 women with overall mean +/- SD age of 53.2 +/- 11.7 years were recruited. Combined gender prevalences were: 21.1% for smoking, 15.5% for drinking, 21.8% for hypertension (systemic blood pressure > or = 140/90 mmHg), 49.8% for impaired fasting plasma glucose (FPG 110-125 mg/dl), 9.9% for diabetes mellitus (FPG > or = 126 mg/dl), 10% for body mass index > or = 30 kg/m2, 43.5% for large waist circumference (WC > or = 90 cm in men and > or = 80 in women), 62.8% for total serum cholesterol (TC), > 200 mg/dl, 38.5% for TC divided by high density lipoprotein cholesterol (HDL-C) > or = 5 and 61.6% for low-density-lipoprotein cholesterol (LDL-C), > or = 130 mg/dl. After using logistic regression, adjusting the effects of age and community of residence, women were less likely than men to be smokers, drinkers, or showed impaired FPG but significantly more likely to have large WC, TC > or = 200 mg/dl and LDL-C > or = 130 mg/dl. Muslims showed significantly lower risk for drinking and large WC but higher risk for low HDL-C. The differences require further research. In conclusion, gender and age have stronger association with various risk factors than ethnicity in this selected population.

Risk factors for a five-year death in the interASIA-south cohort.

OBJECTIVE: To determine the mortality rate and risk factors for death in a selected population in Songkhla province in southern Thailand. MATERIAL AND METHOD: The southern subjects were part of the Thai cohort which together with the cohort from China comprised the InterASIA survey which was conducted in the year 2000. Collected variables were the conventional ones and included the 2 ethnic groups which are specific for southern Thailand, i.e. Malay Muslims and Thai-Chinese Buddhists. Causes of death were determined by reviewing hospital records, verbal autopsies and a consensus by 2-3 physicians. Kaplan Meier's model was used to evaluate the independent factors related to death. RESULTS: The follow-up was 5 years. Out of the original 1,006 subjects, the status could be examined in 86% and of these, 50 had died giving the Kaplan Meier 5-year survival rate of 94.3%. Sixteen died from cardiovascular diseases (CVD), 6 from strokes and 10 from coronary heart disease, and 15 died from cancer. Half of the deaths occurred in subjects older than 70 years. Independent risks for death were age, hypertension and diabetes mellitus. Risk for the major causes of death did not include ethnicity. Similar to the only existing prospective report of risk factors for death in Thailand (the Electricity Generating Authority of Thailand study), neither high total cholesterol, high triglyceride nor obesity were independent risks for death from CVD, but the present study differed in that the high density lipoprotein cholesterol was not found to be a protective factor for CVD death. CONCLUSION: Risk factors for death in a five-year follow-up in Southern Thailand did not include lipids, ethnicity or urbanization but hypertension and diabetes mellitus did.

Prevalence and risk factors of peripheral arterial disease in a selected Thai population.

Peripheral arterial disease (PAD) is a condition with high mortality, but it is amenable to secondary prevention. Data on its prevalence in Thailand are scarce. To study the prevalence of PAD in a middle-class, urban Thai population, a cross-sectional study was conducted at the Electric Generating Authority of Thailand's head plant, Nonthaburi, in 2002 and 2003 on all surviving and contactable employees and former employees who had participated in the first cardiovascular risk factors survey in 1985. Participants completed a structured questionnaire detailing their medical history, and they underwent a physical examination. A diagnosis of PAD was made when the ankle-brachial index (ABI) was < 0.9. Ankle-brachial index data were available for 98% of participants in the survey; 75% were men, and participants' ages ranged from 52 to 73 years. The overall prevalence of PAD was 5.2%. The age-standardized prevalence of PAD was 4% in men and 9% in women. Multiple logistic regression analysis found hypertension (OR = 1.7), female gender (OR = 1.9), current smoking (OR = 3.0), current alcohol drinking (OR = 0.41), and overweight (body mass index [BMI] > 25 kg/m( 2), OR = 0.54) to be significant (P < .05) predictors of PAD. The prevalence of PAD in urban, middle-class Thais was similar to that in the population in developed countries.

A risk score for predicting incident diabetes in the Thai population.

OBJECTIVE: The objective of this study was to develop and evaluate a risk score to predict people at high risk of diabetes in Thailand. RESEARCH DESIGN AND METHODS: A Thai cohort of 2,677 individuals, aged 35-55 years, without diabetes at baseline, was resurveyed after 12 years. Logistic regression models were used to identify baseline risk factors that predicted the incidence of diabetes; a simple model that included only those risk factors as significant (P < 0.05) when adjusted for each other was developed. The coefficients from this model were transformed into components of a diabetes score. This score was tested in a Thai validation cohort of a different 2,420 individuals. RESULTS: A total of 361 individuals developed type 2 diabetes in the exploratory cohort during the follow-up period. The significant predictive variables in the simple model were age, BMI, waist circumference, hypertension, and history of diabetes in parents or siblings A cutoff score of 6 of 17 produced the optimal sum of sensitivity (77%) and specificity (60%). The area under the receiver-operating characteristic curve (AUC) was 0.74. Adding impaired fasting glucose or impaired glucose tolerance status to the model slightly increased the AUC to 0.78; adding low HDL cholesterol and/or high triglycerides barely improved the model. The validation cohort demonstrated similar results. CONCLUSIONS: A simple diabetes risk score, based on a set of variables not requiring laboratory tests, can be used for early intervention to delay or prevent the disease in Thailand. Adding impaired fasting glucose or impaired glucose tolerance or triglyceride and HDL cholesterol status to this model only modestly improves the predictive ability.

Loss of high density lipoprotein cholesterol in serum: effect of storage.

UNLABELLED: The objectives of the study were to determine the magnitude and pattern of loss of detectable high density lipoprotein cholesterol (HDL-C) as functions of time and temperature of storage. Serum from 29 consented adults were estimated for HDL-C (utilising polyethylene glycol and alpha-cyclodextrin) when freshly obtained and after storage at 4 degrees C, -20 degrees C and - 70 degrees C at varied intervals up to a maximum of 120 days. The concentration of fresh HDL-C ranged from 16.9 to 87.2 mg/dl. After 5 days of storing at 4 degrees C, an average of 5% of HDL-C could not be detected. After 120 days of storing at -20 degrees C, 6-8 mg/dl of HDL-C was 'lost, this represented 10-20% of the concentration of the fresh samples. Storage at -70 degrees C resulted in a 'loss' of 3%. The pattern of reduction of detectable HDL-C was such that the initial loss (first few days) was very rapid, reaching a nadir in 20 days. Examining individual serum samples, the loss ranged from minimal up to 30% of the original concentrations for all condition of storage. From further analysis of some portion of the data, there were suggestions that the concentration of triglyceride could be affect the loss of HDL-C with storage. CONCLUSION: Such rate of loss and heterogeneity of loss of detectable HDL-C, so far unexplained, may have implications in the management of epidemiological surveys involving storage of lipids in tropical countries.

Prevalence of cardiovascular risk factors in a rural area in Southern Thailand: potential ethnic differences.

In Thepa district, Songkhla province, Southern Thailand, parents of children being followed long term from conception for their development (N 1325), as well as health workers of the same district (N 150) were surveyed with regards to anthropometry, occupation, family size, food and leisure habits, and blood levels of lipids, sugar, creatinine and hematocrit. Differences among those of Thai or Chinese extracts (Thai-Buddhists) and those of Malay extracts (Thai-Muslims) were separately evaluated for males and females. The mean age for the group (N 1475, including 636 couples) was 31.5 +/- 7.3 (SD) and ranged from 15-66 years. There were 794 females (485 Muslims) ages 29.6 +/- 6.6 (SD). The Muslim families were larger in size averaging 2.8 +/- 1.6 children while the Buddhist's averaged 1.9 +/- 0.9. Fifty four percent of the group were engaged in rubber tapping and this often included both members of the family. Sixty eight percent of the males currently smoked Differences in measured variables between Muslims and Buddhists were minimal. The most striking however was the high density lipoprotein cholesterol (HDL-C) among the males where the age-adjusted average was 51.3 +/- 0.72 (SE) among the Buddhists and 42.2 +/- 0.59 (SE) in the Muslims. This difference was significant even when adjusted for other related variables. Differences in the ethnic groups were also examined in terms of prevalence of risks (hypertension, BMI > or = 25%, waist-hip-ratio, fasting plasma glucose > or = 110 mg%, total cholesterol > or = 200 mg%, triglyceride > or = 150 mg% and low HDL-C). For hypertension (systolic > or = 140 or diastolic > or = 90 mmHg), female Muslims showed higher prevalence (4.5% vs 1.6%; OR 2.82 CI 1.04-7.64). For low HDL-C, male Muslim showed higher prevalence 23.6 vs 8.8%, OR 2.31 CI 1.27-4.22). Other risks showed no differences among the ethnic groups. The differences in parameters or in prevalence of risk between these two ethnic groups (minimal intermarriage) are distinct from differences among Malays and Chinese in Singapore where such differences were subsequently reflected in the differences in incidence and out-come of ischemic heart diseases.

Twelve-year changes in vascular risk factors and their associations with mortality in a cohort of 3499 Thais: the Electricity Generating Authority of Thailand Study.

BACKGROUND: Vascular mortality is increasing in economically developing countries such as Thailand but reliable data about the determinants of these changes are few. METHODS: In 1985, male and female employees of the Electricity Generating Authority of Thailand took part in a cardiovascular risk factor survey. In 1997, a follow-up survey was conducted and causes of death were determined for those subjects known to have died. Changes in levels of vascular risk factors over 12 years, and the associations of baseline risk factors with vascular mortality, were calculated. RESULTS: The 1985 survey recruited 3499 volunteers (average age 43 years) of whom 23% were female. In 1997, vital status was determined for 3318 (95%) and 2967 (85%) of the study participants were resurveyed. Mean levels of systolic blood pressure (SBP) and diastolic blood pressure (DBP), body mass index, total cholesterol and high density lipoprotein (HDL) cholesterol all increased over the 12-year follow-up period. Over the same time, the prevalence of diabetes also rose but the proportion of current smokers decreased. Vascular diseases were the most frequent cause of death during follow-up (n = 46), were positively associated with baseline age, SBP, DBP, smoking, diabetes, male sex, and total cholesterol, and were negatively associated with HDL cholesterol. CONCLUSIONS: Levels of most vascular risk factors worsened over the 12-year period between 1985 and 1997. The associations between baseline risk factor levels and vascular mortality were consistent with those observed in other populations. Interventions that control vascular risk factors have the potential to avert much premature vascular disease in Thailand.

Varidans streptococci in the oral flora of the patients at risk for infective endocarditis: species and penicillin susceptibilities.

This study examined viridans streptococci (SV) in oral flora of patients at risk of infective endocarditis (IE) by obtaining 57 isolates from gum-tooth margin swabs of 3 groups of patients. Penicillin minimal inhibitory concentrations (MICs) were determined by E test. Group 1 was from 30 patients with prosthetic heart valves who did not receive antimicrobial agents within 3 months prior to recruitment. Group 2 consisted of 21 patients with known rheumatic heart diseases who regularly received penicillin prophylaxis. Group 3 was 2 patients with IE caused by SV in whom dental swabs were performed before and on the third day of treatment. Streptococcus mitis was found most frequently (49% among 51 oral isolates of SV from patients in group 1 and 2) and in both blood cultures of IE patients. Ninety-four per cent of the isolates were penicillin-susceptible and the rest were intermediate-resistant (IR) equally distributed in both groups 1 and 2. In 2 patients with IE, oral SV obtained after 3 days of penicillin therapy had MICs rising 3 and 5 folds of the baselines. It is suggested that surveillance of susceptibilities of oral SV in patients at risk for IE should be kept up since this will affect the dose and type of antimicrobial agents in IE prophylaxis.

Consequence and factors related to not offering reperfusion therapy in STEMI.

INTRODUCTION: Varied reasons existed for not offering reperfusion therapy in ST elevation myocardial infarction and results in poor outcomes, and if related factors could be delineated, corrective measures can be attempted. METHOD: We compared variables between participants not receiving reperfusion therapy and those receiving single reperfusion therapy. Multivariate analysis examined the contribution of non-reperfusion therapy to death and factors related to it. RESULTS: Non-reperfusion therapy was older and had a lower frequency of typical chest pain, but more dyspnea, and post cardiac resuscitation. They had more heart failure and death. Non-reperfusion therapy was an independent factor related to cardiac death, and factors related to non-reperfusion therapy were age, type of hospital, presenting features on admission (dyspnea and post cardiac resuscitation), lack of typical chest pain, and not being referred to. CONCLUSION: Non-reperfusion therapy had 2 to 3 times higher in-hospital mortality. Factors related to not offering reperfusion therapy, aside from age, appeared to be amendable to better management.

Prognostic value of selected presenting features of acute coronary syndrome in predicting in-hospital adverse events: insight from the Thai Acute Coronary Syndrome Registry.

OBJECTIVE: To evaluate the relationship of the presenting features of acute coronary syndrome (ACS) to in-hospital adverse events (total and cardiac deaths, heart failure and serious dysrhythmia) and the effects of coronary intervention. BACKGROUND: Patients with ACS may present with dyspnea, shock and/or cardiac arrest with or without accompanying chest pain. METHODS: We evaluated 9,373 patients (age 65+/-12 years and 60% males) enrolled in the Thai ACS Registry. Cardiac dyspnea included shortness of breath on exertion, and/or at rest, orthopnea, or paroxysmal nocturnal dyspnea presumed from cardiac sources. Shock was present if systolic blood pressure was <90 mmHg for >30 min with symptoms of end-organ hypoperfusion. Post cardiac arrest was identified if cardiopulmonary resuscitation was required. We calculated the frequencies of these presenting features and assessed their contribution toward in-hospital adverse events (total and cardiac deaths, heart failure and serious arrhythmias) for the whole ACS and each entity of ACS and the effects of in-hospital interventions, both coronary and medicinal. RESULTS: Cardiac dyspnea, shock and post cardiac arrest were seen in 32.7%, 9.3%, and 4.2% of patients, respectively. In-hospital adverse events occurred more frequently in patients with these presenting features than those without (p<0.05). Cardiac dyspnea and shock were independent predictors of heart failure and death, respectively, while post cardiac arrest independently identified patients at risk of arrhythmia, total and cardiac death, regardless of the subgroup of ACS. Coronary revascularization significantly reduced the risk of total and cardiac death. CONCLUSION: These 3 presenting features of ACS portend a poor prognosis, regardless of the subgroup of ACS and should be considered as important early indicators for early intervention.

Risk factors for development of decreased kidney function in a southeast Asian population: a 12-year cohort study.

End-stage kidney disease has become an increasing burden in all regions of the world. However, limited epidemiologic data on chronic kidney disease in Southeast Asian populations are available. Therefore, a cohort study over a period of 12 yr (1985 to 1997) in 3499 employees of the Electric Generation Authority of Thailand, aged 35 to 55 yr, was conducted to determine the prevalence of decreased kidney function and risk factors associated with future development of decreased kidney function. The prevalence of decreased kidney function (GFR <60 ml/min) increased from 1.7% (95% confidence interval [CI], 1.3 to 2.1) in 1985 to 6.8% (95% CI, 5.7 to 7.9) in 1997, and the prevalence of elevated serum creatinine was 6.1% (95% CI, 5.3 to 6.9) and 16.9% (95% CI, 15.3 to 18.5) in 1985 and 1997 surveys, respectively. The adjusted odds ratio for future development of decreased kidney function was 2.57 (1.0 to 6.81) for systolic hypertension (>159 mmHg), 1.82 (1.12 to 2.98) for hyperuricemia (>6.29 mg/dl), 1.68 (1.02 to 2.77) for elevated body mass index (>24.9 kg/m(2)) compared with subjects with systolic BP <140 mmHg, serum uric acid <4.5 mg/dl, and body mass index 20.8 to 22.8 kg/m(2). The rising prevalence of decreased kidney function in this population resulted mainly from the increasing prevalence of the risk factors in the population. Screening to detect decreased kidney function and early intervention to modify the associated risk factors should be considered in otherwise healthy individuals. Future studies are also necessary to determine whether implementation of these measures results in a reduction of ESRD incidence in the population.