Table 2

Questionnaire in subjects with normal renal function (control group)

INDIVIDUAL PATIENT DATA

Centre:

Identification number:

Sex:

men □

women □

Age:

COMORBIDITIES

Diabetes:

Yes □

No □

Hypertension:

Yes □

No □

Heart failure:

Yes □

No □

Atrial fibrillation:

Yes □

No □

Dyslipidemia:

Yes □

No □

Family history of early cardiovascular disease:

Yes □

No □

Parathyroidectomy

Yes □

No □

LABORATORY DATA

Date ____/____/________

Hemoglobin (g/dl):

Urea (mg/dl):

Hematocrit (%):

Uric acid (mg/dl):

Iron (mg/dl):

Glucose (mg/dl):

Transferrin (mg/dl):

HbA1c (%):

Ferritin (ng/ml):

Insulin (U/l):

Total calcium (mg/dl):

Cystatin C (mg/l):

Phosphorus (mg/dl):

Total cholesterol (mg/dl):

Intact parathormone level (pg/mL):

Triglycerides (mg/dl):

Sodium (mEq/L):

HDL cholesterol (mg/dl):

Potassium (mEq/L):

LDL cholesterol (mg/dl):

Albumin (g/dl):

Hepatitis C virus positive:

Yes □

No □

Creatinin (mg/dl):

Microalbuminuria (mg/l) (urine):

AST/ALT (U/L):

Albumin/creatinin (mg/g) (urine):

MEDICAL TREATMENT

Antihypertensives:

Yes □

No □

Length of treatment (months):

Angiotensio-converting enzyme (ACE) inhibitors:

Yes □

No □

Angiotensin II Receptor Blockers (ARB):

Yes □

No □

Hypolipidemics:

statins □

fibrates □

Length of treatment (months):

Insulin:

Yes □

No □

Oral antidiabetics:

Yes □

No □

Platelet inhibitors:

Yes □

No □

Oral anticoagulants:

Yes □

No □

Junyent et al. BMC Nephrology 2010 11:14   doi:10.1186/1471-2369-11-14