Chronic kidney disease
Chronic kidney disease.
Position paper 2007
Mai Rosenberg 1, Ruth Kalda 1, Vytautas Kasiulevičius 2 , Aivars Petersons 3, Margus Lember 1
1 University of Tartu, Estonia
2 University of Vilnius, Lithania
3 Stradins Medical Academy, Riga, Latvia
Table of contents:
Chronic kidney disease (CKD) is a worldwide public health problem that is often under-diagnosed and under-treated.
Definitions and classification
Chronic kidney disease represents a progressive, irreversible decline in glomerular filtration rate (1). Most chronic nephropathies unfortunately lack a specific treatment and progress relentlessly to end stage renal disease. Progressive renal function loss is a common phenomenon in renal failure irrespectively of the underlying cause of the kidney disease (2).
In recent years the concept of chronic kidney disease has gained more attention instead of chronic renal failure which is used to describe the more advanced stages of CKD. This is especially important for primary health care where the role of primary care providers is very important in handling the early phases of CKD to prevent or postpone chronic renal failure. In the current literature the terms CKD, renal insufficiency and renal failure are sometimes used without precisely defining these conditions.
Chronic renal failure indicates to chronically (at least 3 months' duration) reduced kidney function (clearance, glomerular filtration rate [GFR]). Renal function declines normally with age, and exact level of decline at a given age that should be considered pathological is not known.The Kidney Disease Improving Global Outcomes (KDIGO) statement considers GFR less than 60 mL/minute pathological at all ages. However, many elderly people have values less than this (in the USA, about 7% of white people without diabetes who are aged in their 60s and 15% of those aged in their 70s), and the extent to which low kidney function in the range of 30–60 mL/minute/1.73 m2 is pathological or progressive in all people is a subject of some controversy. Though people with end stage renal disease, by definition, have chronic failure of their kidneys (which may have resulted from an acute or a chronic process) they are generally not included in the term chronic renal failure, which in most of the literature and in this chapter refers exclusively to those with low kidney function who are not treated with renal replacement therapy.
Chronic kidney disease defined by the Kidney Disease Improving Global Outcomes (KDIGO) statement as either the presence of abnormalities in urine or imaging that may lead to progressive disease or creatinine clearance (or glomerular filtration rate) less than 60 mL/minute/1.73 m2 . Chronic kidney disease includes chronic renal failure, but also includes predictors of chronic renal failure in people with normal kidney function (e.g. proteinuria), and end stage renal disease.
The National Kidney Foundation - Kidney Disease Outcomes Quality Initiative (NKF-K/DOQI) workgroup has defined CKD as the following (10) which have been accepted internationally with some clarifications (7,11):
· The presence of markers of kidney damage for
· The presence of GFR <60 mL/min/1.73 m2 for 3 months, with or without other signs of kidney damage as described above.
Based upon representative samples of the United States population (12), the studies have estimated the prevalence of CKD in the general population through measurement of markers of kidney damage, such as elevated serum creatinine concentration, decreased predicted GFR, and presence of albuminuria. The term “albuminuria” should be substituted for terms “microalbuminuria” and “macroalbuminuria”. Increased urinary albumin excretion of albumin is the earliest manifestation of CKD due to diabetes, other glomerular diseases and hypertensive nephrosclerosis. Albuminuria may also accompany tubulointerstitial diaseases, polycysistic kidney disease, and kidney disease in transplant recipients (11).
According to the KD:IGO position statement (11) the use of the term “disease” in CKD is consistent with: 1) the need for action to improve outcomes through prevention, detection, evaluation and treatment; 2) providing a message for public, physician and patient education programs; 3) common usage; and 4) its use in other conditions defined by findings and laboratory tests, such as hypertension, diabetes, and hyperlipidemia (11).
Classification of CKD.
CKD classified according to the severity, diagnosis, treatment and prognosis (11). Suffix “T” is used for all transplant recipients, at any level of GFR and, “D” for dialysis, for CKD stage 5 patients treated with dialysis. Clinical evaluation for CKD should include elucidation of the cause of disease. However, cause of the disease cannot be ascertained in all cases.
GFR (mL/min per 1.73 m2)
Kidney damage with normal or ↑ GFR
Kidney damage with mild ↓ GFR
“T” if kidney transplant recipient
Moderate ↓ GFR
Chronic renal insufficiency
Early renal insufficiency
Severe ↓ GFR
Chronic renal insufficiency
Late renal insufficiency
End-stage renal disease
“D” if dialysis (HD, PD)
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