Clarifying the concept of chronic kidney disease for non-nephrologists
EntityUAM. Departamento de Medicina; Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD)
PublisherOxford University Press on behalf of ERA-EDTA
10.1093/ckj/sfz007Clinical Kidney Journal 12.2 (2019): 258–261
ISSN2048-8505 (print); 2048-8513 (online)
Funded byThis research was supported by FIS PI16/02057, ISCIII-RETIC REDinREN RD016/0009 FEDER funds, Sociedad Española de Nefrología, Fundación Renal Iñigo Ávarez de Toledo (FRIAT), ISCIII Rio Hortega (MVPG) and Comunidad de Madrid Biomedicina B2017/BMD-3686 CIFRA2-CM.
ProjectGobierno de España. PI16/02057; Gobierno de España. RD016/0009; Comunidad de Madrid. B2017/BMD-3686/CIFRA2
SubjectsAlbuminuria; Chronic kidney disease; Creatinine clearance; Definition; Glomerular filtration rate; Urate; Medicina
Rights© 2019 The Authors
Esta obra está bajo una licencia de Creative Commons Reconocimiento-NoComercial 4.0 Internacional.
Chronic kidney disease (CKD) expands the prior concept of chronic renal insufficiency by including patients with relatively preserved renal function, as assessed by the estimated glomerular filtration rate (eGFR), as even these early CKD stages are associated with an increased risk for all-cause death and cardiovascular death, CKD progression and acute kidney injury. A decreased eGFR (<60 mL/min/1.73m2) is by itself diagnostic of CKD when persisting for >3 months. However, when eGFR is 60 mL/min/1.73m2, an additional criterion is required to diagnose CKD. In a recent clinical trial published in The New England Journal of Medicine, all 6190 participants were reported to have CKD: 47% had Stages 1 and 2 CKD and 53% had Stage 3 CKD. This illustrates a widespread misunderstanding of the concept of CKD. Moreover, CKD categories in this study were assigned based on the estimated creatinine clearance. Since both estimated creatinine clearance and creatinine clearance overestimate eGFR, this illustrates another frequent misunderstanding: equating GFR with creatinine clearance. In this commentary, we clarify the concept of CKD and of CKD categories for non-nephrologists. Assigning a diagnosis of CKD to a patient with normal renal function and absence of other evidence of CKD may have negative consequences for the individual (e.g. insurance and others) as well as for the medical community at large by creating confusion about the concept.
Google Scholar:Pérez-Gómez, Maria Vanessa - Bartsch, Lorenz-Alexander - Castillo-Rodríguez, Esmeralda - Fernández-Prado, Raúl - Fernández-Fernández, Beatriz - Martín-Cleary, Catalina - Gracia-Iguacel, Carolina - Ortiz Arduán, Alberto
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