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An epidemic of chronic kidney disease: fact or fiction?
1 The David Geffen School of Medicine at UCLA, Los Angeles, CA, USA 2 Oxford Kidney Unit, Oxford Radcliffe Hospital, Oxford, UK
Richard J. Glassock, 8 Bethany, Laguna Niguel, CA 92677, USA. Email: glassock@cox.net
Keywords: chronic kidney disease; estimated glomerular filtration rate; KDOQI; KDIGO
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Introduction |
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The publication of the Kidney Disease Outcomes and Quality Initiative (KDOQI) clinical practice guidelines for the evaluation, classification and stratification of chronic kidney disease (CKD) in February of 2002 was a landmark event [1]. This effort has profoundly impacted clinical practice, helped bring some order to a chaotic system of nomenclature and stimulated a resurgence of interest in this long-neglected domain of clinical nephrology [2]. The nephrology community is now using a definition of the five stages of CKD, based on the presence of ‘kidney damage’ and/or reduced estimated glomerular filtration rate (eGFR) for 3 months or more [1,3]. However, it is noteworthy that three of the five stages of CKD (stages 3, 4 and 5) were arbitrarily defined and based solely on the absolute threshold of eGFR (standardized to 1.73 m2 body surface area) without any requirement for concomitant evidence of
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The ‘epidemic’ of chronic kidney disease |
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Need for new ‘cut-off’ values for eGFR to define chronic kidney ‘disease’ |
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Overestimation of chronic kidney disease burden and suggestions for corrective action |
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