Andrew S. Levey, MD; Josef Coresh, MD, PhD; Ethan Balk, MD, MPH; Annamaria T. Kausz, MD, MS; Adeera Levin, MD; Michael W. Steffes, MD, PhD; Ronald J. Hogg, MD; Ronald D. Perrone, MD; Joseph Lau, MD; Garabed Eknoyan, MD
Acknowledgments: The authors thank the members of the K/DOQI Support Group and Advisory Board and the National Kidney Foundation.
Grant Support: In part by the National Kidney Foundation.
Potential Financial Conflicts of Interest:Honoraria: A.T. Kausz (Amgen); Lecturer: J. Coresh (Roche Pharmaceuticals, Amgen).
Requests for Single Reprints: Kerry Willis, PhD, National Kidney Foundation, 30 East 33rd Street, Suite 1100, New York, NY 10016; e-mail, email@example.com.
Current Author Addresses: Drs. Levey, Kausz, and Perrone: Division of Nephrology, New England Medical Center, Box 391, 750 Washington Street, Boston, MA 02111.
Dr. Coresh: Welch Center for Prevention, Epidemiology and Clinical Research, 2024 East Monument Avenue, Baltimore, MD 21205.
Drs. Balk and Lau: Division of Clinical Care Research, New England Medical Center, Box 63, 750 Washington Street, Boston, MA 02111.
Dr. Levin: Division of Nephrology, St. Paul's Hospital, University of British Columbia, #602-1160 Burrad Street, Vancouver, British Columbia, Canada V6Z 2E8.
Dr. Steffes: Department of Laboratory Medicine and Pathology, University of Minnesota, Box 609 Mayo Building, 420 Delaware Street SE, Minneapolis, MN 55455.
Dr. Hogg: Division of Pediatric Nephrology, North Texas Hospital for Children, 777 Forest Lane, Suite C-740, Dallas, TX 75230-2505.
Dr. Eknoyan: Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030.
Chronic kidney disease is a worldwide public health problem with an increasing incidence and prevalence, poor outcomes, and high cost. Outcomes of chronic kidney disease include not only kidney failure but also complications of decreased kidney function and cardiovascular disease. Current evidence suggests that some of these adverse outcomes can be prevented or delayed by early detection and treatment. Unfortunately, chronic kidney disease is underdiagnosed and undertreated, in part as a result of lack of agreement on a definition and classification of its stages of progression.
Recent clinical practice guidelines by the National Kidney Foundation 1) define chronic kidney disease and classify its stages, regardless of underlying cause, 2) evaluate laboratory measurements for the clinical assessment of kidney disease, 3) associate the level of kidney function with complications of chronic kidney disease, and 4) stratify the risk for loss of kidney function and development of cardiovascular disease. The guidelines were developed by using an approach based on the procedure outlined by the Agency for Healthcare Research and Quality.
This paper presents the definition and five-stage classification system of chronic kidney disease and summarizes the major recommendations on early detection in adults. Recommendations include identifying persons at increased risk (those with diabetes, those with hypertension, those with a family history of chronic kidney disease, those older than 60 years of age, or those with U.S. racial or ethnic minority status), detecting kidney damage by measuring the albumincreatinine ratio in untimed (spot) urine specimens, and estimating the glomerular filtration rate from serum creatinine measurements by using prediction equations. Because of the high prevalence of early stages of chronic kidney disease in the general population (approximately 11% of adults), this information is particularly important for general internists and specialists.
Table 1. Guidelines, Recommendations, Ratings, and Key References
Table 2. National Kidney Foundation Kidney Disease Outcomes Quality Initiative Rating of the Strength of Recommendations
Evidence model for stages in the initiation and progression of chronic kidney disease (CKD) and therapeutic interventions.blackdark graylight graywhiteGFR
Table 3. Risk Factors for Chronic Kidney Disease and Its Outcomes
Table 4. National Kidney Foundation Kidney Disease Outcomes Quality Initiative Classification, Prevalence, and Action Plan for Stages of Chronic Kidney Disease
Table 5. Clues to the Diagnosis of Chronic Kidney Disease from the Patient's History
Table 6. Laboratory Evaluation of Patients with Chronic Kidney Disease and Persons at Increased Risk for Chronic Kidney Disease
Table 7. Prevalence of Persons at Increased Risk for Chronic Kidney Disease
Evaluation of proteinuria in patients not known to have kidney disease.
Appendix Table 1. Serum Creatinine Corresponding to an Estimated Glomerular Filtration Rate of 60 mL/min per 1.73 m2 by the Abbreviated Modification of Diet in Renal Disease Study and CockcroftGault Equations
Appendix Table 2. National Kidney Foundation Kidney Disease Outcomes Quality Initiative Rating the Strength of Evidence
Levey AS, Coresh J, Balk E, et al. National Kidney Foundation Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification. Ann Intern Med. 2003;139:137–147. doi: https://doi.org/10.7326/0003-4819-139-2-200307150-00013
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Published: Ann Intern Med. 2003;139(2):137-147.
Chronic Kidney Disease, Guidelines, Nephrology.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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