National Kidney Foundation Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification

  1. Andrew S. Levey, MD;
  2. Josef Coresh, MD, PhD;
  3. Ethan Balk, MD, MPH;
  4. Annamaria T. Kausz, MD, MS;
  5. Adeera Levin, MD;
  6. Michael W. Steffes, MD, PhD;
  7. Ronald J. Hogg, MD;
  8. Ronald D. Perrone, MD;
  9. Joseph Lau, MD; and
  10. Garabed Eknoyan, MD
  1. 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.
    1. Figure 1. Shaded ellipses represent stages of chronic kidney disease; unshaded ellipses represent potential antecedents or consequences of chronic kidney disease. Thick arrows between ellipses represent risk factors associated with the initiation and progression of disease that can be affected or detected by interventions: susceptibility factors ( ), initiation factors ( ), progression factors ( ), and end-stage factors ( ) (Table 3). Interventions for each stage are given beneath the stage. Persons who appear normal should be screened for chronic kidney disease risk factors. Persons known to be at increased risk for chronic kidney disease should be screened for chronic kidney disease. “Complications” refer to all complications of chronic kidney disease and its treatment, including complications of decreased glomerular filtration rate ( ) (hypertension, anemia, malnutrition, bone disease, neuropathy, and decreased quality of life) and cardiovascular disease. Reprinted with permission from reference .
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      Figure 1. Shaded ellipses represent stages of chronic kidney disease; unshaded ellipses represent potential antecedents or consequences of chronic kidney disease. Thick arrows between ellipses represent risk factors associated with the initiation and progression of disease that can be affected or detected by interventions: susceptibility factors ( ), initiation factors ( ), progression factors ( ), and end-stage factors ( ) (Table 3). Interventions for each stage are given beneath the stage. Persons who appear normal should be screened for chronic kidney disease risk factors. Persons known to be at increased risk for chronic kidney disease should be screened for chronic kidney disease. “Complications” refer to all complications of chronic kidney disease and its treatment, including complications of decreased glomerular filtration rate ( ) (hypertension, anemia, malnutrition, bone disease, neuropathy, and decreased quality of life) and cardiovascular disease. Reprinted with permission from reference . Evidence model for stages in the initiation and progression of chronic kidney disease (CKD) and therapeutic interventions.blackdark graylight graywhiteGFR7
    2. Figure 2. The Work Group recommends a cutoff value for an albumin–creatinine ratio greater than 30 mg/g in men and women. Some studies suggest sex-specific cutoff values for an albumin–creatinine ratio of greater than 17 mg/g in men or greater than 25 mg/g in women . Reprinted with permission from reference .
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      Figure 2. The Work Group recommends a cutoff value for an albumin–creatinine ratio greater than 30 mg/g in men and women. Some studies suggest sex-specific cutoff values for an albumin–creatinine ratio of greater than 17 mg/g in men or greater than 25 mg/g in women . Reprinted with permission from reference . Evaluation of proteinuria in patients not known to have kidney disease.(10, 11)7

    Summary for Patients

    • Summaries for Patients:Diagnosis and Evaluation of Patients with Chronic Kidney Disease: Recommendations from the National Kidney Foundation Ann Intern Med July 15, 2003 139:I-36
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    1. Ann Intern Med July 15, 2003 vol. 139 no. 2 137-147
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