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Chronic kidney disease is common: What do we do next?
1 Johns Hopkins Medical Institutions, Baltimore, MD 2 Division of Nephrology, Tufts-New England Medical Center, Boston, MA, USA
Josef Coresh, Johns Hopkins Medical Institutions, Baltimore, MD, USA. E-mail: alevey@tufts-nemc.org
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Introduction |
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Glassock and Winearls thoughtfully acknowledge some of the major gains made as a result of the standardized guidelines for the definition, evaluation, classification and stratification of chronic kidney disease (CKD) as well as point out a number of concerns [1]. We agree with the distinction between a clear epidemic rise in the number and rate of treated kidney failure [also known as end-stage renal disease (ESRD)] in the United States and other countries and much weaker data about trends in earlier stages of CKD. There is also high prevalence of earlier CKD stages 1–4 and a growing literature about associated consequences. We will briefly discuss trends in treated kidney failure, trends in earlier stages of CKD, the rationale for a single GFR cutoff for the definition of CKD, and our view of promising approaches for future research and practice in CKD. We recognize that population estimates of the
Kidney failure
Treated kidney failure is epidemic and has become common.
CKD stages 1–4
eGFR is a useful first step in CKD detection, evaluation and management, but not the last step.
Strengths and limitations of GFR estimation.
CKD prevalence in the United States is common and increasing.
Do we need to change the eGFR cutoff value for the definition of CKD?
We agree with Drs Glassock and Winearls that a ‘disadvantage’-based definition is appropriate, but do not agree with the proposal to use age-specific percentiles.
The disparity between the prevalence of earlier stages of CKD and incidence of treated kidney failure across race and sex should not be taken as conclusive evidence for inaccuracies of the GFR estimating equations or inadequacy of the current GFR cutoff value.
Risk-based approaches should consider multiple risks.
GFR declines with age but how do we know if this is ‘normal’.
What next?
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