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Clinical Implications of Estimating Equations for Glomerular Filtration Rate

Lesley A. Stevens, MD; and Andrew S. Levey, MD
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From Tufts-New England Medical Center, Boston, MA 02111.

Acknowledgments: The authors thank Josef Coresh, MD, PhD; Tom Greene, PhD; and Tom Hostetter, MD, for contributing greatly to the ideas described here.

Grant Support: In part by grant R01 DK53869-05 from the National Institutes of Health (Dr. Levey).

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Lesley A. Stevens, MD, Division of Nephrology, Tufts-New England Medical Center, 750 Washington Street, Box #391, Boston, MA 02111; e-mail, lstevens1@tufts-nemc.org.

Current Author Addresses: Drs. Stevens and Levey: Division of Nephrology, Tufts-New England Medical Center, 750 Washington Street, Box #391, Boston, MA 02111.

Ann Intern Med. 2004;141(12):959-961. doi:10.7326/0003-4819-141-12-200412210-00013
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Chronic kidney disease is a major public health problem, with increasing incidence and prevalence, poor outcomes, and high costs (12). In the United States, the estimated prevalence of all stages of chronic kidney disease is 20 million (1), and the number of patients receiving dialysis should exceed 650 000 by 2010 (2). Long-term adverse outcomes associated with chronic kidney disease include kidney failure, complications of impaired kidney function, and, more commonly, an increased risk for cardiovascular disease and death (3). The clinical practice guidelines of the National Kidney Foundation's Kidney Disease Quality Outcome Initiative (NKF-K/DQOI) defined chronic kidney disease as a glomerular filtration rate (GFR) less than 60 mL/min per 1.73 m2 or the presence of kidney damage for 3 or more months, regardless of cause (4). The guidelines also provided a system for staging the severity of kidney disease, primarily on the basis of GFR, with stage-specific recommendations for evaluation and management (Table).

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