Paul E. Stevens, MBBS, BSc; Adeera Levin, MD, BSc; for the Kidney Disease: Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group Members*
Acknowledgment: The authors thank the KDIGO co-chairs Bertram L. Kasiske, Kai-Uwe Eckardt, David C. Wheeler; the evidence review team (Katrin Uhlig, Dana C. Miskulin, Amy Earley, Shana Haynes, Michael Cheung); and all those who provided feedback during the public review of the draft guideline.
Potential Conflicts of Interest: Dr. Levin: Consultancy (money to institution): Abbott Laboratories, Merck & Co; Grants/grants pending (money to institution): Canadian Institutes of Health Research (CIHR), Kidney Foundation, Merck & Co, Ortho. Dr. Stevens: None disclosed. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-0034.
Requests for Single Reprints: Paul E. Stevens, MBBS, BSc, Kent Kidney Care Centre, Kent and Canterbury Hospital, Ethelbert Road, Canterbury, Kent CT1 3NG, United Kingdom; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Stevens: Kent Kidney Care Centre, Kent and Canterbury Hospital, Ethelbert Road, Canterbury, Kent CT1 3NG, United Kingdom.
Dr. Levin: St. Paul's Hospital, Providence Wing, Room 6010A, 1160 Burrard Street, Vancouver, British Columbia V6Z 1Y8, Canada.
Author Contributions: Conception and design: A. Levin.
Analysis and interpretation of the data: A. Levin.
Drafting of the article: P.E. Stevens, A. Levin.
Critical revision for important intellectual content: P.E. Stevens, A. Levin.
Final approval of the article: P.E. Stevens, A. Levin.
Administrative, technical, or logistic support: A. Levin.
Collection and assembly of data: A. Levin.
Stevens PE, Levin A, for the Kidney Disease: Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group Members*. Evaluation and Management of Chronic Kidney Disease: Synopsis of the Kidney Disease: Improving Global Outcomes 2012 Clinical Practice Guideline. Ann Intern Med. 2013;158:825-830. doi: 10.7326/0003-4819-158-11-201306040-00007
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Published: Ann Intern Med. 2013;158(11):825-830.
The Kidney Disease: Improving Global Outcomes (KDIGO) organization developed clinical practice guidelines in 2012 to provide guidance on the evaluation, management, and treatment of chronic kidney disease (CKD) in adults and children who are not receiving renal replacement therapy.
The KDIGO CKD Guideline Development Work Group defined the scope of the guideline, gathered evidence, determined topics for systematic review, and graded the quality of evidence that had been summarized by an evidence review team. Searches of the English-language literature were conducted through November 2012. Final modification of the guidelines was informed by the KDIGO Board of Directors and a public review process involving registered stakeholders.
The full guideline included 110 recommendations. This synopsis focuses on 10 key recommendations pertinent to definition, classification, monitoring, and management of CKD in adults.
Appendix Table 1. GRADE Criteria Used for Grade Levels in the KDIGO CKD Guideline
Appendix Table 2. GRADE Criteria Used for Letter Grades in the KDIGO CKD Guideline
Appendix Table 3. Topics Chosen for Systematic Review
1.1.1. CKD is defined as abnormalities of kidney structure or function, present for >3 months, with implications for health. (Not Graded)
Table 1. Criteria for Chronic Kidney Disease
1.2.1. We recommend that CKD is classified based on cause, GFR category, and albuminuria category (CGA). (1B)
Table 2. GFR and Albuminuria Categories in the New Classification
220.127.116.11. We suggest measuring cystatin C in adults with eGFRcreat [creatinine-based eGFR] 45-59 ml/min/1.73 m2 who do not have other markers of kidney damage if confirmation of CKD is required. (2C)
18.104.22.168. We recommend that clinical laboratories report albumin:creatinine ratios (ACR) and protein:creatinine ratios (PCR) in untimed urine samples in addition to albumin concentration or proteinuria concentrations rather than the concentrations alone. (1B)
22.214.171.124.1. The term microalbuminuria should no longer be used by laboratories. (Not Graded)
Guide to frequency of monitoring by GFR and albuminuria categories.
This GFR and albuminuria grid reflects the risk for progression by intensity of coloring. The numbers in the boxes are a guide to the frequency of monitoring (number of times per year). Reproduced from reference 2. ACR = albumin–creatinine ratio; CKD = chronic kidney disease; GFR = glomerular filtration rate.
3.1.4 We recommend that both diabetic and non-diabetic adults with CKD and urine albumin excretion <30 mg/24 hours (or equivalent) whose office BP is consistently >140 mm Hg systolic or >90 mm Hg diastolic be treated with BP-lowering drugs to maintain a BP that is consistently ≤140 mm Hg systolic and ≤90 mm Hg diastolic. (1B)
3.1.5 We suggest that both diabetic and non-diabetic adults with CKD and with urine albumin excretion of ≥30 mg/24 hours (or equivalent) whose office BP is consistently >130 mm Hg systolic or >80 mm Hg diastolic be treated with BP-lowering drugs to maintain a BP that is consistently ≤130 mm Hg systolic and ≤80 mm Hg diastolic. (2D)
3.1.7 We recommend that an ARB [angiotensin-receptor blocker] or ACE-I [angiotensin-converting enzyme inhibitor] be used in both diabetic and non-diabetic adults with CKD and urine albumin excretion >300 mg/24 hours (or equivalent). (1B)
3.1.12. We recommend that all people with CKD are considered to be at increased risk of AKI. (1A)
4.1.2 We recommend that the level of care for ischemic heart disease offered to people with CKD should not be prejudiced by their CKD. (1A)
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