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15 July 2003 | Volume 139 Issue 2 | Pages 137-147
Chronic kidney disease is a worldwide public health problem with an increasing incidence and prevalence, poor outcomes, and high cost. Outcomes of chronic kidney disease include not only kidney failure but also complications of decreased kidney function and cardiovascular disease. Current evidence suggests that some of these adverse outcomes can be prevented or delayed by early detection and treatment. Unfortunately, chronic kidney disease is underdiagnosed and undertreated, in part as a result of lack of agreement on a definition and classification of its stages of progression.
Recent clinical practice guidelines by the National Kidney Foundation 1) define chronic kidney disease and classify its stages, regardless of underlying cause, 2) evaluate laboratory measurements for the clinical assessment of kidney disease, 3) associate the level of kidney function with complications of chronic kidney disease, and 4) stratify the risk for loss of kidney function and development of cardiovascular disease. The guidelines were developed by using an approach based on the procedure outlined by the Agency for Healthcare Research and Quality.
This paper presents the definition and five-stage classification system of chronic kidney disease and summarizes the major recommendations on early detection in adults. Recommendations include identifying persons at increased risk (those with diabetes, those with hypertension, those with a family history of chronic kidney disease, those older than 60 years of age, or those with U.S. racial or ethnic minority status), detecting kidney damage by measuring the albumin–creatinine ratio in untimed ("spot") urine specimens, and estimating the glomerular filtration rate from serum creatinine measurements by using prediction equations. Because of the high prevalence of early stages of chronic kidney disease in the general population (approximately 11% of adults), this information is particularly important for general internists and specialists.
Author and Article Information
From Tufts-New England Medical Center and Tufts University School of Medicine, Boston, Massachusetts; Bloomberg School of Public Health, Welch Center for Prevention, Epidemiology and Clinical Research, and the Johns Hopkins University, Baltimore, Maryland; University of British Columbia, Vancouver, British Columbia, Canada; University of Minnesota, Minneapolis, Minnesota; North Texas Hospital for Children, Dallas, Texas; and Baylor College of Medicine, Houston, Texas.
Acknowledgments: The authors thank the members of the K/DOQI Support Group and Advisory Board and the National Kidney Foundation.
Grant Support: In part by the National Kidney Foundation.
Potential Financial Conflicts of Interest:Honoraria: A.T. Kausz (Amgen); Lecturer: J. Coresh (Roche Pharmaceuticals, Amgen).
Requests for Single Reprints: Kerry Willis, PhD, National Kidney Foundation, 30 East 33rd Street, Suite 1100, New York, NY 10016; e-mail, kerryw{at}kidney.org.
Current Author Addresses: Drs. Levey, Kausz, and Perrone: Division of Nephrology, New England Medical Center, Box 391, 750 Washington Street, Boston, MA 02111.
Dr. Coresh: Welch Center for Prevention, Epidemiology and Clinical Research, 2024 East Monument Avenue, Baltimore, MD 21205.
Drs. Balk and Lau: Division of Clinical Care Research, New England Medical Center, Box 63, 750 Washington Street, Boston, MA 02111.
Dr. Levin: Division of Nephrology, St. Paul's Hospital, University of British Columbia, #602-1160 Burrad Street, Vancouver, British Columbia, Canada V6Z 2E8.
Dr. Steffes: Department of Laboratory Medicine and Pathology, University of Minnesota, Box 609 Mayo Building, 420 Delaware Street SE, Minneapolis, MN 55455.
Dr. Hogg: Division of Pediatric Nephrology, North Texas Hospital for Children, 777 Forest Lane, Suite C-740, Dallas, TX 75230-2505.
Dr. Eknoyan: Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030. CLINICAL GUIDELINES
National Kidney Foundation Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification
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M. L. Melamed, P. Muntner, E. D. Michos, J. Uribarri, C. Weber, J. Sharma, and P. Raggi Serum 25-Hydroxyvitamin D Levels and the Prevalence of Peripheral Arterial Disease: Results from NHANES 2001 to 2004 Arterioscler. Thromb. Vasc. Biol., June 1, 2008; 28(6): 1179 - 1185. [Abstract] [Full Text] [PDF]
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 Hospitalization Discharge Diagnoses for Kidney Disease--United States, 1980-2005 JAMA, May 14, 2008; 299(18): 2144 - 2145. [Full Text] [PDF]
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S. J. Shah, T. Thenappan, S. Rich, L. Tian, S. L. Archer, and M. Gomberg-Maitland Association of Serum Creatinine With Abnormal Hemodynamics and Mortality in Pulmonary Arterial Hypertension Circulation, May 13, 2008; 117(19): 2475 - 2483. [Abstract] [Full Text] [PDF]
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K. Dimopoulos, G.-P. Diller, E. Koltsida, A. Pijuan-Domenech, S. A. Papadopoulou, S. V. Babu-Narayan, T. V. Salukhe, M. F. Piepoli, P. A. Poole-Wilson, N. Best, et al. Prevalence, Predictors, and Prognostic Value of Renal Dysfunction in Adults With Congenital Heart Disease Circulation, May 6, 2008; 117(18): 2320 - 2328. [Abstract] [Full Text] [PDF]
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 M. P Bjorkman, A. J Sorva, and R. S Tilvis Elevated serum parathyroid hormone predicts impaired survival prognosis in a general aged population Eur. J. Endocrinol., May 1, 2008; 158(5): 749 - 753. [Abstract] [Full Text] [PDF]
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C. Lorenzo, S. D. Nath, A. J.G. Hanley, H. E. Abboud, and S. M. Haffner Relation of Low Glomerular Filtration Rate to Metabolic Disorders in Individuals without Diabetes and with Normoalbuminuria Clin. J. Am. Soc. Nephrol., May 1, 2008; 3(3): 783 - 789. [Abstract] [Full Text] [PDF]
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C. M. Pfeiffer, J. D. Osterloh, J. Kennedy-Stephenson, M. F. Picciano, E. A. Yetley, J. I. Rader, and C. L. Johnson Trends in Circulating Concentrations of Total Homocysteine among US Adolescents and Adults: Findings from the 1991-1994 and 1999-2004 National Health and Nutrition Examination Surveys Clin. Chem., May 1, 2008; 54(5): 801 - 813. [Abstract] [Full Text] [PDF]
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 J. Shepherd, J. J.P. Kastelein, V. Bittner, P. Deedwania, A. Breazna, S. Dobson, D. J. Wilson, A. Zuckerman, N. K. Wenger, and for the TNT (Treating to New Targets) Investigator Intensive Lipid Lowering With Atorvastatin in Patients With Coronary Heart Disease and Chronic Kidney Disease: The TNT (Treating to New Targets) Study J. Am. Coll. Cardiol., April 15, 2008; 51(15): 1448 - 1454. [Abstract] [Full Text] [PDF]
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Y. Amsalem, M. Garty, R. Schwartz, A. Sandach, S. Behar, A. Caspi, S. Gottlieb, D. Ezra, B. S. Lewis, and J. Leor Prevalence and significance of unrecognized renal insufficiency in patients with heart failure Eur. Heart J., April 2, 2008; 29(8): 1029 - 1036. [Abstract] [Full Text] [PDF]
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C. C. Miller III, M. A. Villa, P. Achouh, A. L. Estrera, A. Azizzadeh, S. M. Coogan, E. E. Porat, and H. J. Safi Intraoperative skeletal muscle ischemia contributes to risk of renal dysfunction following thoracoabdominal aortic repair Eur. J. Cardiothorac. Surg., April 1, 2008; 33(4): 691 - 694. [Abstract] [Full Text] [PDF]
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 B. D. Bushnell, J. K. Horton, M. F. McDonald, and P. G. Robertson Perioperative Medical Comorbidities in the Orthopaedic Patient J. Am. Acad. Ortho. Surg., April 1, 2008; 16(4): 216 - 227. [Abstract] [Full Text] [PDF]
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M. Kimmel, M. Butscheid, S. Brenner, U. Kuhlmann, U. Klotz, and D. M. Alscher Improved estimation of glomerular filtration rate by serum cystatin C in preventing contrast induced nephropathy by N-acetylcysteine or zinc--preliminary results Nephrol. Dial. Transplant., April 1, 2008; 23(4): 1241 - 1245. [Abstract] [Full Text] [PDF]
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G. C. Kane, A. W. Stanson, D. Kalnicka, D. W. Rosenthal, C. U. Lee, S. C. Textor, and V. D. Garovic Comparison between gadolinium and iodine contrast for percutaneous intervention in atherosclerotic renal artery stenosis: clinical outcomes Nephrol. Dial. Transplant., April 1, 2008; 23(4): 1233 - 1240. [Abstract] [Full Text] [PDF]
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G. Liew, P. Mitchell, T. Y. Wong, S. K. Iyengar, and J. J. Wang CKD Increases the Risk of Age-Related Macular Degeneration J. Am. Soc. Nephrol., April 1, 2008; 19(4): 806 - 811. [Abstract] [Full Text] [PDF]
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