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Challenges for the present CKD classification system.

Ron T Gansevoort¹, Paul E de Jong

¹Department of Nephrology, University Medical Center Groningen, Groningen, The Netherlands. R.T.Gansevoort@int.umcg.nl

Current Opinion in Nephrology and Hypertension

|February 27, 2010

Summary

The current chronic kidney disease (CKD) classification needs updates. Splitting stage 3 CKD and including albuminuria information can improve accuracy for better patient risk assessment.

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Area of Science:

Nephrology
Internal Medicine
Epidemiology

Background:

The Kidney Disease Outcomes Quality Initiative (K/DOQI) introduced a widely adopted CKD classification in 2002.
Concerns regarding the initial CKD classification system emerged shortly after its implementation.

Purpose of the Study:

To review major concerns raised about the K/DOQI CKD classification system.
To propose adaptations to the current CKD classification based on recent evidence.

Main Methods:

Review of recent literature on chronic kidney disease classification and GFR estimation.
Analysis of epidemiological findings related to CKD staging and risk.

Main Results:

The Modification of Diet in Renal Disease (MDRD) equation for GFR estimation is generally useful but has limitations in specific populations.
Cystatin C-based equations offer a promising alternative for GFR estimation.
Proposed adaptations include splitting CKD stage 3 into two substages and incorporating albuminuria data into all CKD classes.
Individuals with GFR 45-60 ml/min/1.73 m2 and no albuminuria are generally not at high risk for disease progression and may not require a CKD label.
No strong rationale supports age-specific cut-off values for CKD diagnosis.

Conclusions:

Recent epidemiological data support adapting the CKD classification system.
Proposed modifications aim to achieve renewed broad acceptance for the CKD classification.