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 □ |