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Time to differentiate ‘decreased kidney function’ from ‘kidney disease’: towards improving the definition of chronic kidney disease

International Urology and Nephrology volume 44, pages 493–497 (2012)Cite this article

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.

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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

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Affiliations

  1. Division of Clinical Sciences, Northern Ontario School of Medicine, Laurentian and Lakehead Universities, Sudbury & Thunder Bay, ON, Canada

    Malvinder S. Parmar

  2. Timmins and District Hospital, Medical Office Building, Suite E, 640 Ross Ave. East, Timmins, ON, P4N 8P2, Canada

    Malvinder S. Parmar

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  1. Malvinder S. Parmar
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Correspondence to Malvinder S. Parmar.

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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

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  • DOI: https://doi.org/10.1007/s11255-011-0115-7

Keywords

  • Chronic kidney disease
  • Estimated glomerular filtration rate
  • Kidney function