 |
 |
|
| |||||||||||||||||||||||||||||||||||||||||||||||||
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
Related articles in Annals:
This article has been cited by other articles:
|
|
 |
|
  A. H. Brantsma, S. J. L. Bakker, H. L. Hillege, D. de Zeeuw, P. E. de Jong, R. T. Gansevoort, and for the PREVEND Study Group Cardiovascular and renal outcome in subjects with K/DOQI stage 1-3 chronic kidney disease: the importance of urinary albumin excretion Nephrol. Dial. Transplant., December 1, 2008; 23(12): 3851 - 3858. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P B. Bookstaver, J. W Johnson, T. P McCoy, D. Stewart, and J. C Williamson Modification of Diet in Renal Disease and Modified Cockcroft-Gault Formulas in Predicting Aminoglycoside Elimination Ann. Pharmacother., December 1, 2008; 42(12): 1758 - 1765. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. K. Kramer, C. B. Leitao, L. H. Canani, and J. L. Gross Impact of White-Coat Hypertension on Microvascular Complications in Type 2 Diabetes Diabetes Care, December 1, 2008; 31(12): 2233 - 2237. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V. L. Ng, A. Fecteau, R. Shepherd, J. Magee, J. Bucuvalas, E. Alonso, S. McDiarmid, G. Cohen, R. Anand, and and the Studies of Pediatric Liver Transplantation Outcomes of 5-Year Survivors of Pediatric Liver Transplantation: Report on 461 Children From a North American Multicenter Registry Pediatrics, December 1, 2008; 122(6): e1128 - e1135. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Guy, R. Newall, J. Borzomato, P. A. Kalra, and C. Price Use of a first-line urine protein-to-creatinine ratio strip test on random urines to rule out proteinuria in patients with chronic kidney disease Nephrol. Dial. Transplant., November 12, 2008; (2008) gfn612v2. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Pizzarelli, F. Lauretani, S. Bandinelli, G. B. Windham, A. M. Corsi, S. V. Giannelli, L. Ferrucci, and J. M. Guralnik Predictivity of survival according to different equations for estimating renal function in community-dwelling elderly subjects Nephrol. Dial. Transplant., November 6, 2008; (2008) gfn594v1. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. H. Fox, A. Swanson, L. S. Kahn, K. Glaser, and B. M. Murray Improving Chronic Kidney Disease Care in Primary Care Practices: An Upstate New York Practice-based Research Network (UNYNET) Study J Am Board Fam Med, November 1, 2008; 21(6): 522 - 530. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V. W. Sung, R. G. Rogers, J. I. Schaffer, E. M. Balk, K. Uhlig, J. Lau, H. Abed, T. L. Wheeler II, M. Y. Morrill, J. L. Clemons, et al. Graft Use in Transvaginal Pelvic Organ Prolapse Repair: A Systematic Review Obstet. Gynecol., November 1, 2008; 112(5): 1131 - 1142. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. N. Ibrahim, C. Wang, A. Ishani, A. J. Collins, and R. N. Foley Screening for Chronic Kidney Disease Complications in US Adults: Racial Implications of a Single GFR Threshold Clin. J. Am. Soc. Nephrol., November 1, 2008; 3(6): 1792 - 1799. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Pitt, G. Bakris, L. M. Ruilope, L. DiCarlo, R. Mukherjee, and on Behalf of the EPHESUS Investigators Serum Potassium and Clinical Outcomes in the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS) Circulation, October 14, 2008; 118(16): 1643 - 1650. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Pilz, W. Marz, B. Wellnitz, U. Seelhorst, A. Fahrleitner-Pammer, H. P. Dimai, B. O. Boehm, and H. Dobnig Association of Vitamin D Deficiency with Heart Failure and Sudden Cardiac Death in a Large Cross-Sectional Study of Patients Referred for Coronary Angiography J. Clin. Endocrinol. Metab., October 1, 2008; 93(10): 3927 - 3935. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. G. Shellock and A. Spinazzi MRI Safety Update 2008: Part 1, MRI Contrast Agents and Nephrogenic Systemic Fibrosis Am. J. Roentgenol., October 1, 2008; 191(4): 1129 - 1139. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. L. Melamed, C. Bauer, and T. H. Hostetter eGFR: Is It Ready for Early Identification of CKD? Clin. J. Am. Soc. Nephrol., September 1, 2008; 3(5): 1569 - 1572. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Ryu, Y. Chang, H.-Y. Woo, S.-G. Kim, D.-I. Kim, W. S. Kim, B.-S. Suh, N.-K. Choi, and J.-T. Lee Changes in Body Weight Predict CKD in Healthy Men J. Am. Soc. Nephrol., September 1, 2008; 19(9): 1798 - 1805. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Wertman, , BA, E. Altun, D. R. Martin, D. G. Mitchell, J. R. Leyendecker, R. B. O'Malley, D. J. Parsons, E. R. Fuller III, and R. C. Semelka Risk of Nephrogenic Systemic Fibrosis: Evaluation of Gadolinium Chelate Contrast Agents at Four American Universities Radiology, September 1, 2008; 248(3): 799 - 806. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. I. Steinman, A. E. Samir, and L. D. Cornell Case 27-2008 -- A 64-Year-Old Man with Abdominal Pain, Nausea, and an Elevated Level of Serum Creatinine N. Engl. J. Med., August 28, 2008; 359(9): 951 - 960. [Full Text] [PDF]
|
|
|
|
|
|
P. Ochodnicky, R. H. Henning, H. Buikema, A. C. A. Kluppel, M. v. Wattum, D. de Zeeuw, and R. P. E. van Dokkum Renal endothelial function and blood flow predict the individual susceptibility to adriamycin-induced renal damage Nephrol. Dial. Transplant., August 26, 2008; (2008) gfn483v1. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Thadhani and C. G. Solomon Preeclampsia -- A Glimpse into the Future? N. Engl. J. Med., August 21, 2008; 359(8): 858 - 860. [Full Text] [PDF]
|
|
|
|
|
|
R. K. Greenberg, Q. Lu, E. E. Roselli, L. G. Svensson, M. C. Moon, A. V. Hernandez, J. Dowdall, M. Cury, C. Francis, K. Pfaff, et al. Contemporary Analysis of Descending Thoracic and Thoracoabdominal Aneurysm Repair: A Comparison of Endovascular and Open Techniques Circulation, August 19, 2008; 118(8): 808 - 817. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. L. Melamed, E. D. Michos, W. Post, and B. Astor 25-Hydroxyvitamin D Levels and the Risk of Mortality in the General Population Arch Intern Med, August 11, 2008; 168(15): 1629 - 1637. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. J. Howell, B. E. Keogh, R. S. Bonser, T. R. Graham, J. Mascaro, S. J. Rooney, I. C. Wilson, and D. Pagano Mild renal dysfunction predicts in-hospital mortality and post-discharge survival following cardiac surgery. Eur. J. Cardiothorac. Surg., August 1, 2008; 34(2): 390 - 395. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Chonchol, H. Gnahn, and D. Sander Impact of subclinical carotid atherosclerosis on incident chronic kidney disease in the elderly Nephrol. Dial. Transplant., August 1, 2008; 23(8): 2593 - 2598. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Almond, S. Siddiqui, S. Robertson, J. Norrie, and C. Isles Comparison of combined urea and creatinine clearance and prediction equations as measures of residual renal function when GFR is low QJM, August 1, 2008; 101(8): 619 - 624. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Targher, M. Chonchol, L. Bertolini, S. Rodella, L. Zenari, G. Lippi, M. Franchini, G. Zoppini, and M. Muggeo Increased Risk of CKD among Type 2 Diabetics with Nonalcoholic Fatty Liver Disease J. Am. Soc. Nephrol., August 1, 2008; 19(8): 1564 - 1570. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. W. Payne Jr., L. Littmann, S. Burtey, B. Dussol, P. Brunet, S. K. Goyal, S. R. Punnam, K. Nasir, M. J. Budoff, R. Blumenthal, et al. Coronary Calcium and Events in Four Ethnic Groups N. Engl. J. Med., July 10, 2008; 359(2): 202 - 204. [Full Text] [PDF]
|
|
|
|
|
|
S. M. Bagshaw Short- and long-term survival after acute kidney injury Nephrol. Dial. Transplant., July 1, 2008; 23(7): 2126 - 2128. [Full Text] [PDF]
|
|
|
|
 |
|
 B. Ovbiagele Impairment in Glomerular Filtration Rate or Glomerular Filtration Barrier and Occurrence of Stroke Arch Neurol, July 1, 2008; 65(7): 934 - 938. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. L. White, K. McGeechan, M. Jones, A. Cass, S. J. Chadban, K. R. Polkinghorne, V. Perkovic, and P. J. Roderick Socioeconomic Disadvantage and Kidney Disease in the United States, Australia, and Thailand Am J Public Health, July 1, 2008; 98(7): 1306 - 1313. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. R. Herts, E. Schneider, E. D. Poggio, N. A. Obuchowski, and M. E. Baker Identifying Outpatients with Renal Insufficiency before Contrast-enhanced CT by Using Estimated Glomerular Filtration Rates versus Serum Creatinine Levels Radiology, July 1, 2008; 248(1): 106 - 113. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. B. Patwardhan, D. B. Matchar, G. P. Samsa, and W. E. Haley Opportunities for Improving Management of Advanced Chronic Kidney Disease American Journal of Medical Quality, June 1, 2008; 23(3): 184 - 192. [Abstract] [PDF]
|
|
|
|
 |
|
 M. S. Joy, M. La, and Bo Xiao Individualizing Therapy in Patients With Chronic Kidney Disease Journal of Pharmacy Practice, June 1, 2008; 21(3): 225 - 236. [Abstract] [PDF]
|
|
|
|
|
|
A. Meyer, H. Bunzemeier, M. Hausberg, M. Walter, N. Roeder, G. Breithardt, and H. Reinecke Impact of different stages of chronic kidney disease on in-hospital costs in patients with coronary heart disease Nephrol. Dial. Transplant., June 1, 2008; 23(6): 1955 - 1960. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. G. Loef, R. H. Henning, G. Navis, A. J. Rankin, W. van Oeveren, T. Ebels, and A. H. Epema Changes in glomerular filtration rate after cardiac surgery with cardiopulmonary bypass in patients with mild preoperative renal dysfunction Br. J. Anaesth., June 1, 2008; 100(6): 759 - 764. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. D. Dangour, E. Breeze, R. Clarke, P. S. Shetty, R. Uauy, and A. E. Fletcher Plasma Homocysteine, but Not Folate or Vitamin B-12, Predicts Mortality in Older People in the United Kingdom J. Nutr., June 1, 2008; 138(6): 1121 - 1128. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Meisinger, W. Koenig, J. Baumert, and A. Doring Uric Acid Levels Are Associated With All-Cause and Cardiovascular Disease Mortality Independent of Systemic Inflammation in Men From the General Population: The MONICA/KORA Cohort Study Arterioscler. Thromb. Vasc. Biol., June 1, 2008; 28(6): 1186 - 1192. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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]
|
|
|
|
 |
|
 Hospitalization Discharge Diagnoses for Kidney Disease--United States, 1980-2005 JAMA, May 14, 2008; 299(18): 2144 - 2145. [Full Text] [PDF]
|
|
|
|
|
|
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]
|
|
|
|
|
|
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]
|
|
|
|
 |
|
 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]
|
|
|
|
|
|
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]
|
|
|
|
 |
|
 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]
|
|
|
|
 |
|
 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]
|
|
|
|
 |
|
 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]
|
|
|
|
|
|
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]
|
|
|
|
 |
|
 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]
|
|
|
|
|
|
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]
|
|
|
|
|
|
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]
|
|
|
|
|
|
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]
|
|
|
|
 |
|
 K. A. Griffin, H. Kramer, and A. K. Bidani Adverse renal consequences of obesity Am J Physiol Renal Physiol, April 1, 2008; 294(4): F685 - F696. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Bankir, M. Bochud, M. Maillard, P. Bovet, A. Gabriel, and M. Burnier Nighttime Blood Pressure and Nocturnal Dipping Are Associated With Daytime Urinary Sodium Excretion in African Subjects Hypertension, April 1, 2008; 51(4): 891 - 898. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Cirillo, M. P. Lanti, A. Menotti, M. Laurenzi, M. Mancini, A. Zanchetti, and N. G. De Santo Definition of Kidney Dysfunction as a Cardiovascular Risk Factor: Use of Urinary Albumin Excretion and Estimated Glomerular Filtration Rate Arch Intern Med, March 24, 2008; 168(6): 617 - 624. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Melloni, E. D. Peterson, A. Y. Chen, L. A. Szczech, L. K. Newby, R. A. Harrington, W. B. Gibler, E. M. Ohman, S. A. Spinler, M. T. Roe, et al. Cockcroft-Gault versus modification of diet in renal disease: importance of glomerular filtration rate formula for classification of chronic kidney disease in patients with non-ST-segment elevation acute coronary syndromes. J. Am. Coll. Cardiol., March 11, 2008; 51(10): 991 - 996. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
|
Article
