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Diane L Frankenfield*
Curtis A Johnson**
*Office of Research, Development and Information
Centers for Medicare & Medicaid Services
**School of Pharmacy
University of Wisconsin in Madison
Chronic kidney disease (CKD) is a global public health problem. Currently, there are five recognised stages of CKD, based on glomerular filtration rate (GFR), ranging from GFR ≥90ml/min/1.73m(2) (stage 1) to GFR <ml/min/1.73m(2) (stage 5 or end-stage renal disease).(1) The Australian Diabetes, Obesity and Lifestyle Study (AusDiab) estimated that the prevalence of at least one indicator of CKD among adult patients screened between April 1999 and December 2000 was 18%, with 12.1% having renal impairment, defined as a calculated GFR <ml/min/1.73m(2). Data from the Third National Health and Nutrition Examination Survey (NHANES III) revealed that in 1988-94 and 1999-2000, 11% and 12% of adults in the USA, respectively, had CKD using gender-specific albumintocreatinine ratio (ACR) cutoffs.(3,4) Several studies on the epidemiology of CKD in Europe have concluded that the prevalence of CKD among European adults is at least as high as that found in the USA.(5) The incidence of end-stage renal disease (CKD stage 5) has been increasing at a rate of 6