Inclusion of albumin as a target in therapy guidelines: guidelines for chronic kidney disease

Slowing the rate of progression of chronic kidney disease (CKD) as a fundamental management goal has been greatly assisted by the development of clinical practice guidelines under the aegis of the National Kidney Foundation, through the K/DOQI process. Reductions in urinary protein and albumin excretion play important roles in these treatment strategies, with numerous studies describing short- and long-term successes in these endeavors. These approaches may also reduce the risks of cardiovascular and cerebrovascular morbidity and mortality, and of developing new onset diabetes mellitus. With enhanced sensitivity assays for urinary albumin, and the near-term availability of point-of-service testing, we will have the opportunity to address reduction of urinary albumin excretion as a defined goal and critical element in management of CKD. Carefully conducted clinical trials are needed to establish the utility of these assays, and to define optimal strategies for reducing urinary albumin excretion. With the successful outcomes of these studies, the reduction of urinary albumin excretion will receive its due emphasis in the management of patients with CKD.