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Definition and staging of chronic kidney disease in adults

Authors
Andrew S Levey, MD
Lesley A Inker, MD, MS
Section Editor
Gary C Curhan, MD, ScD
Deputy Editor
John P Forman, MD, MSc

INTRODUCTION

The definition and classification of chronic kidney disease (CKD) guidelines were introduced by the National Kidney Foundation (NKF) Kidney Disease Outcomes Quality Initiative (KDOQI) in 2002, and were subsequently adopted with minor modifications by the international guideline group Kidney Disease Improving Global Outcomes (KDIGO) in 2004 [1-3].

These CKD guidelines shifted the concept of kidney disease from that of an uncommon life-threatening condition requiring care by nephrologists to that of a common condition with a range of severity meriting attention by general internists, and demanding strategies for prevention, early detection, and management [4,5]. The guidelines had a major effect on clinical practice, research, and public health, but also generated substantial controversy [6-11].

The most recent definition and classification of CKD will be addressed here. Discussions pertaining to the assessment of kidney function, the epidemiology of CKD, screening for CKD, evaluation of patients with CKD, overview of the management of CKD, and the association between CKD and cardiovascular disease are presented elsewhere. (See "Assessment of kidney function" and "Epidemiology of chronic kidney disease" and "Screening for chronic kidney disease" and "Diagnostic approach to the patient with subacute kidney injury in an outpatient setting" and "Overview of the management of chronic kidney disease in children" and "Chronic kidney disease and coronary heart disease".)

CONTROVERSIES ADDRESSED BY THE NEW GUIDELINES

In 2009, KDIGO convened a Controversies Conference to address key areas of controversy and review data on more than 1.5 million individuals from 45 cohorts that was assembled by the CKD Prognosis Consortium [12-16]. The following controversies were among those discussed:

Should the albuminuria threshold to define CKD continue to be 30 mg/day (or equivalent)?

                     

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Literature review current through: Nov 2016. | This topic last updated: Wed Nov 16 00:00:00 GMT+00:00 2016.
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