NEWS

KDIGO Reaches Consensus on CKD Staging

San Diego, CA – Predicting prognosis for chronic kidney disease (CKD) patients could be improved by emphasizing classification by cause in addition to stage, by adding albuminuria stages in addition to GFR and by subdividing CKD stage 3 into two stages. These proposed modifications to the current CKD classification system, recommended by consensus during a recent Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference, will be presented on November 1, along with a brief conference report, at the American Society of Nephrology’s Renal Week, held here.

More than fifty cohort studies submitted data for review at the Controversies Conference, drawing from meta-analyses on 1.5 million study participants.  The data reviewed showed a strong, consistent gradation in risk for all outcomes of CKD, according to the level of estimated GFR and urine albumin-to-creatinine ratio (ACR) across a wide range of study populations. In general, increased risk was noted below a level of GFR around 60 ml/min/1.73 m2 and at urinary ACR at all levels above 10 mg/g (the lowest value examined). The risk for cardiovascular mortality and kidney disease outcomes tended to be elevated at a higher GFR than all-cause mortality.

“The consensus reached was not to change the definition of CKD based on reduced GFR or urine ACR >30 mg/g as a marker of kidney damage, but that the current classification did need modification because it did not adequately describe the prognosis of CKD.  By adding cause of disease and albuminuria stage to the classification system, we can correlate staging better to patient outcomes. This may be particularly helpful in the elderly, in whom reduced GFR is common,” said Andrew Levey, MD, conference chair and Chief, Division of Nephrology at Tufts University School of Medicine.

“By subdividing CKD Stage 3 into two stages, with the first comprising GFR of 45-59 ml/min1.73 m2 and the second comprising GFR of 30-44 ml/min1.73, we can define a group of patients at significantly higher risk for poor cardiovascular and kidney outcomes” said Joseph Coresh, MD.

As a consequence of this landmark meeting, it is anticipated that revision of the 2002 KDOQI clinical practice guidelines on definition and classification of CKD will be undertaken by KDIGO in the near future.  “The debate reflects a tension in our field caused by the paradigm shift about the basic perspective on CKD – from kidney failure as a life-threatening illness to earlier stages of kidney disease as the target for prevention, detection, evaluation and management.   While change is always difficult, especially for those in its midst, the debate has been healthy, and the discussions and consensus should enable us to move on and work across disciplines to improve outcomes for our patients,” continued Dr. Levey.

KDIGO, a global non-profit foundation managed by the National Kidney Foundation, is dedicated to improving the care and outcomes of kidney disease patients worldwide through promoting coordination, collaboration, and integration of initiatives to develop and implement clinical practices guidelines.