NDT Advance Access originally published online on December 17, 2007
Nephrology Dialysis Transplantation 2008 23(5):1765-1766; doi:10.1093/ndt/gfm840
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
About CKD stage-3 subdivision proposal
Correspondence and offprint requests to: E-mail: plsantacruz{at}cantv.netSir,
I have read very carefully the paper published in a recent issue of NDT about DOQI-NKF classification of CKD stage-3 related [1]. In short, Abutaleb et al. proposed subdividing CKD-3 into two stages: 3a and 3b, respectively.
There is no doubt that CKD is increasing in a dramatic way, and is recognized as a global public health problem, representing a heavy burden not only for the patients, but also for their families and for the society [2,3]. On the other hand, CKD patients are more likely to die, mainly from cardiovascular disease (CVD) before progressing to stage 5 [4].
On this theme, it would be good to remember the Hoorn study, which demonstrated that mild renal function impairment was associated with a significant CV mortality when glomerular filtration rate (GFR) was <70 ml/min/ 1.73 m2bs with an important increase in the risk of CV death by each 5 ml/min/1.73 m2 decrease [5]; this might be a plausible explanation for the highly different death rates among CKD stages 3 and 4.
I agree with the use of two subdivisions of 15 ml/min/ 1.73 m2bs ranged components, 3a (GFR 59–45 ml/min/ 1.73 m2bs) and 3b (GFR 44–30 ml/min/1.73 m2bs) because it seems logical to think this would help to define more accurately the level within CKD stage 3 at which mortality becomes a real problem for the international nephrology community, health authorities and of course, patients and their relatives.
However, as a current point of view, renal transplantation must continue to be considered as a form of renal replacement therapy (RRT), because even though successful kidney transplantation results in an improved quality of life and is certainly a better therapeutic option than haemodialysis or peritoneal dialysis, unfortunately it is not always possible to reach complete renal recovery. Besides, the transplant recipient will require a permanent immunosuppressive regimen and close medical control; furthermore, nowhere in the world are there sufficient human kidney donors for patients with CKD-5, waiting for a renal transplantation.
For those reasons among others, we believe it impossible to develop a global strategy to recommend kidney allograft as a standard modality of treatment for CKD stage 3 or 4.
We believe that the cornerstone in the global struggle against CKD, especially for developing countries, is PREVENTION.
Conflict of Interest Statemen: None declared.
Program of Renal Health CORPOSALUD-Aragua, Universidad Bicentenaria de Aragua, Maracay, Aragua State, Venezuela
References
- Abutaleb N. Why we should subdivide CKD stage 3 into early (3a) and late (3b) components. Nephrol Dial Transplant (2007) 22:2728–2729.
[Free Full Text] - Levey AS, Atkins R, Coresh J, et al. Chronic kidney disease as a global public health problem: approaches and initiatives—a position statement from kidney disease improving global outcomes. Kidney Int (2007) 72:247–259.[CrossRef][Web of Science][Medline]
- Hamer RA, El Nahas AM. The burden of chronic kidney disease. BMJ (2006) 332:563–564.
[Free Full Text] - Gil P, Justo S, Caramelo C. Cardio-renal failure: an emerging clinical entity. Nephrol Dial Transplant (2005) 20:1780–1783.
[Free Full Text] - Henry RMA, Kostense PJ, Bos G, et al. Mild renal insufficiency is associated with increased cardiovascular mortality: the Hoorn study. Kidney Int (2003) 62:1402–1407.[CrossRef][Web of Science]
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||