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Editorials |

Classification of Chronic Kidney Disease: A Step Forward

Andrew S. Levey, MD; Navdeep Tangri, MD; and Lesley A. Stevens, MD, MS
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From Tufts Medical Center, Boston, MA 02111.


Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-2555.

Requests for Single Reprints: Andrew S. Levey, MD, Tufts Medical Center, Box 391, 800 Washington Street, Boston, MA 02111.

Current Author Addresses: Drs. Levey, Tangri, and Stevens: Tufts Medical Center, Box 391, 800 Washington Street, Boston, MA 02111.


Ann Intern Med. 2011;154(1):65-67. doi:10.7326/0003-4819-154-1-201101040-00012
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In this issue, Tonelli and colleagues compared a new classification for patients with CKD that incorporates eGFR and proteinuria with the current system that considers only eGFR. The editorialists conclude that adding proteinuria to GFR stages enables better description of CKD prognosis, but further study is needed on whether use of prognostic instruments improves CKD management and patient outcomes.

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Figure.
Risk categories for kidney and mortality outcomes, by GFR and albuminuria or proteinuria stage.

ACR = albumin–creatinine ratio; CKD = chronic kidney disease; GFR = glomerular filtration rate; KDIGO = Kidney Disease: Improving Global Outcomes. Top. Risk categories based on a composite ranking of 5 outcomes by the Chronic Kidney Disease Prognosis Consortium for the KDIGO Conference, London, 2009. The lowest-risk categories (no CKD) are not shaded; moderate-, high-, and very high–risk categories are shaded from lightest to darkest green. Modified from Kidney International and reproduced from Levey and colleagues (13) with permission of KDIGO. Bottom. Risk categories based on a composite ranking of 2 outcomes by Tonelli and colleagues (14). Risk group 0 (no CKD) is not shaded, and groups 1 2, 3 and 4 are indicated with progressively darker shades of green. For comparison with the KDIGO figure, we have added a sixth GFR category (<15 mL/min per 1.73 m2), shaded darkest green.

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