Scientific truths are all provisional. Most of science falls away as new paradigms emerge … (Richard Smith, former editor of BMJ).
Abstract
Chronic kidney disease (CKD) has become an ‘epidemic’ worldwide, since the publication of K/DOQI guidelines in 2002. This classification indeed has raised the profile of CKD worldwide. However, despite limitations of the glomerular filtration rate (GFR) estimating equations, the majority of this epidemic is caused by the large number of persons with stage 3 CKD, with many elderly individuals with ‘low-normal GFR’ being diagnosed with CKD, when, in fact, the majority of those may not have the disease, and a handful of resources being utilized in investigating these relatively ‘low-risk patients’ with ‘decreased eGFR’ without CKD. Recently, concerns have been raised by nephrologists about this classification system, and I strongly feel that it is important to differentiate ‘decreased kidney function’ from ‘kidney disease’, as the GFR estimating equations predict renal function only and nothing else; therefore, I propose some modifications to improve the current classification, so that limited resources and efforts are effectively focused on managing high-risk patients.
Similar content being viewed by others
References
Coresh J et al (2005) Chronic kidney disease awareness, prevalence, trends among U.S. adults, 1999 to 2000. J Am Soc Nephrol 16(1):180–188
National Kidney Foundation (2002) kidney disease outcomes quality initiative, clinical practice guidelines for chronic kidney disease: evaluation, classification and stratification. Am J Kidney Dis 39(Suppl 1):S1–S266
Parmar MS (2002) Chronic renal disease. BMJ 325(7355):85–90
Zhang QL, Rothenbacher D (2008) Prevalence of chronic kidney disease in population-based studies: systematic review. BMC Public Health 8:117
Imai E, Horio M, Yamagata K, Eseki K, Hara S, Ura N, Kiyohara Y, Makino H, Hishida A, Matsuo S (2008) Slower decline of glomerular filtration rate in the Japanese general population: a longitudinal 10-year follow-up study. Hypertn Res 31(3):433–441
Chiu YL et al (2008) Outcomes of stage 3–5 chronic kidney disease before end-stage renal disease at a single center in Taiwan. Nephron Clin Pract 109(3):c109–c118
Rule AD et al (2006) Limitations of estimating glomerular filtration rate from serum creatinine in the general population. Mayo Clin Proc 81(11):1427–1434
Delanaye P, Cohen EP (2008) Formula-based estimates of the GFR: equations variable and uncertain. Nephron Clin Pract 110(1):c48–c53 discussion c54
Glassock RJ, Winearls C (2008) An epidemic of chronic kidney disease: fact or fiction? Nephrol Dial Transplant 23(4):1117–1121
Bauer C, Melamed ML, Hostetter TH (2008) Staging of chronic kidney disease: time for a course correction. J Am Soc Nephrol 19(5):844–846
Glassock RJ, Winearls C (2008) Screening for CKD with eGFR: doubts and dangers. Clin J Am Soc Nephrol 3(5):1563–1568
Glassock RJ, Winearls CG (2008) Routine reporting of estimated glomerular filtration rate: not ready for prime time. Nat Clin Pract Nephrol 4(8):422–423
Poggio ED, Rule AD (2009) A critical evaluation of chronic kidney disease—should isolated reduced estimated glomerular filtration rate be considered a ‘disease’? Nephrol Dial Transplant 24(3):698–700
Eckardt KU et al (2009) Definition and classification of CKD: the debate should be about patient prognosis—a position statement from KDOQI and KDIGO. Am J Kidney Dis 53(6):915–920
Levey AS et al (2011) The definition, classification, and prognosis of chronic kidney disease: a KDIGO controversies conference report. Kidney Int 80(1):17–28
Wetzels JF et al (2007) Age- and gender-specific reference values of estimated GFR in Caucasians: the Nijmegen Biomedical Study. Kidney Int 72(5):632–637
Levey AS et al (1999) A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of diet in Renal Disease Study Group. Ann Intern Med 130(6):461–470
Eriksen BO, Ingebretsen OC (2006) The progression of chronic kidney disease: a 10-year population-based study of the effects of gender and age. Kidney Int 69(2):375–382
Coresh J et al (2007) Prevalence of chronic kidney disease in the United States. JAMA 298(17):2038–2047
Ishani A et al (2006) Association of single measurements of dipstick proteinuria, estimated glomerular filtration rate, and hematocrit with 25-year incidence of end-stage renal disease in the multiple risk factor intervention trial. J Am Soc Nephrol 17(5):1444–1452
Foster MC et al (2007) Cross-classification of microalbuminuria and reduced glomerular filtration rate: associations between cardiovascular disease risk factors and clinical outcomes. Arch Intern Med 167(13):1386–1392
Bakris GL, Weir MR (2000) Angiotensin-converting enzyme inhibitor-associated elevations in serum creatinine: is this a cause for concern? Arch Intern Med 160(5):685–693
Mann JF et al (2008) Renal outcomes with telmisartan, ramipril, or both, in people at high vascular risk (the ONTARGET study): a multicentre, randomised, double-blind, controlled trial. Lancet 372(9638):547–553
Shulman NB et al (1989) Prognostic value of serum creatinine and effect of treatment of hypertension on renal function. Results from the hypertension detection and follow-up program. The Hypertension Detection and Follow-up Program Cooperative Group. Hypertension 13(5 Suppl):180–193
Go AS et al (2004) Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 351(13):1296–1305
de Jong PE et al (2008) Screening for chronic kidney disease: where does Europe go? Clin J Am Soc Nephrol 3(2):616–623
Brantsma AH et al (2008) Cardiovascular and renal outcome in subjects with K/DOQI stage 1–3 chronic kidney disease: the importance of urinary albumin excretion. Nephrol Dial Transplant 23(12):3851–3858
Tonelli M et al (2006) Proteinuria, impaired kidney function, and adverse outcomes in people with coronary disease: analysis of a previously conducted randomised trial. BMJ 332(7555):1426
de Jong PE, Gansevoort RT (2008) Fact or fiction of the epidemic of chronic kidney disease—let us not squabble about estimated GFR only, but also focus on albuminuria. Nephrol Dial Transplant 23(4):1092–1095
Crowe E, Halpin D, Stevens P (2008) Early identification and management of chronic kidney disease: summary of NICE guidance. BMJ 337:a1530
Levey AS et al (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150(9):604–612
Stevens LA et al (2010) Comparative performance of the CKD Epidemiology Collaboration (CKD-EPI) and the Modification of Diet in Renal Disease (MDRD) Study equations for estimating GFR levels above 60 mL/min/1.73 m2. Am J Kidney Dis 56(3):486–495
Peralta CA et al (2011) Detection of chronic kidney disease with creatinine, cystatin C, and urine albumin-to-creatinine ratio and association with progression to end-stage renal disease and mortality. JAMA 305(15):1545–1552
Acknowledgments
I am greatly indebted and would like to thank Dr. Dimitrios G Oreopolous, Professor of Medicine, University Health Network, Toronto, Ontario, and Dr. Alexander Ross Morton, Professor of Medicine, Queen’s University, Kingston, Ontario, for their thoughtful and helpful comments.
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Parmar, M.S. Time to differentiate ‘decreased kidney function’ from ‘kidney disease’: towards improving the definition of chronic kidney disease. Int Urol Nephrol 44, 493–497 (2012). https://doi.org/10.1007/s11255-011-0115-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11255-011-0115-7