We searched the Cochrane Library, Medline, and Embase up to the end of August, 2009, with the search terms “chronic kidney disease” or “chronic renal insufficiency” in combination with “diagnosis”, “screening”, “prevention”, “control”, “treatment”, or “intervention”. Largely, we selected publications from the past 10 years from journals with high impact factors but did not exclude frequently referenced and highly regarded older publications. We also searched the reference lists of
SeriesEarly recognition and prevention of chronic kidney disease
Introduction
Chronic kidney disease is a common disorder that is associated with raised risk of cardiovascular disease, kidney failure, and other complications. The ageing of populations along with the growing global prevalence of diabetes and other chronic non-communicable diseases has led to corresponding worldwide increases in prevalence of chronic kidney disease and kidney failure. Strategies for early identification and treatment of people with chronic kidney disease, who are at risk of cardiovascular events and progression to the end stage of chronic kidney disease (kidney failure), are needed worldwide, especially in countries where renal replacement is not readily available. This Review will discuss potential strategies for early identification and treatment of such high-risk patients to reduce morbidity and mortality associated with later stages of chronic kidney disease.
Section snippets
Definition, classification, and staging
Chronic kidney disease is defined by a sustained reduction in glomerular filtration rate or evidence of structural or functional abnormalities of the kidneys on urinalysis, biopsy, or imaging.1, 2, 3 A five-stage classification system for the disorder has been established by the US National Kidney Foundation's Kidney Disease Outcomes Quality Initiative and adopted internationally by the Kidney Disease: Improving Global Outcomes (KDIGO) initiative to guide identification of cases and facilitate
Epidemiology
The prevalence of chronic kidney disease has been estimated in several developed countries but remains unknown in much of the developing world.15 Adoption of standard definitions and use of the MDRD study equation for estimated glomerular filtration rate have facilitated international comparisons. When chronic kidney disease is defined solely by estimated glomerular filtration rates less than 60 mL per min 1·73 m2, approximate prevalence is 2·5–11·2% of the adult population across Europe, Asia,
Strategies for early recognition
Early identification of patients with chronic kidney disease is desirable because interventions can then be implemented to reduce risk of cardiovascular events or progression to kidney failure. The high prevalence of chronic kidney disease,15 absence of symptoms until disease is advanced, accessibility of laboratory tests for diagnosis and prognostication,51 and availability of treatments that prevent complications suggest that screening for chronic kidney disease could be worthwhile. However,
Prevention and intervention
Initial management of chronic kidney disease entails identification of reversible disorders (such as urinary-tract obstruction, infection, or autoimmune disease) that could respond to specific treatment and lead to stabilisation or improvement in kidney function. Irrespective of underlying cause, typical goals of management for all patients with chronic kidney disease include prevention of cardiovascular events and reduction of the rate of progression of the disorder (thereby delaying or
Further challenges and directions
Better clinical methods are needed to distinguish patients at risk of adverse renal and cardiovascular outcomes to permit best use of resources. The use of predictive techniques that combine estimated glomerular filtration rate and proteinuria might represent one such potential advance. Novel biomarkers could help to identify individuals at risk of progressive chronic kidney disease and kidney failure in the future. Although effective interventions to slow the progression of diabetic and
Search strategy and selection criteria
References (136)
- et al.
Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO)
Kidney Int
(2005) - et al.
Prevalence and factors associated with CKD: a population study from Beijing
Am J Kidney Dis
(2008) - et al.
Revised equations for estimated GFR from serum creatinine in Japan
Am J Kidney Dis
(2009) - et al.
Serum cystatin C is superior to serum creatinine as a marker of kidney function: a meta-analysis
Am J Kidney Dis
(2002) - et al.
Estimating GFR using serum cystatin C alone and in combination with serum creatinine: a pooled analysis of 3,418 individuals with CKD
Am J Kidney Dis
(2008) - et al.
Prevalence of chronic kidney disease in population-based studies: systematic review
BMC Public Health
(2008) - et al.
Epidemiology of chronic renal disease in the Galician population: results of the pilot Spanish EPIRCE study
Kidney Int Suppl
(2005) - et al.
All-cause mortality attributable to chronic kidney disease: a prospective cohort study based on 462 293 adults in Taiwan
Lancet
(2008) - et al.
Chronic kidney disease in the elderly: is it really a premise for overwhelming renal failure?
Kidney Int
(2006) - et al.
Association between obesity and kidney disease: a systematic review and meta-analysis
Kidney Int
(2008)
The changing patterns of chronic kidney disease: the need to develop strategies for prevention relevant to different regions and countries
Kidney Int Suppl
Moderate renal insufficiency and the risk of cardiovascular mortality: results from the NHANES I
Kidney Int
The risk of acute renal failure in patients with chronic kidney disease
Kidney Int
A population-based study of the incidence and outcomes of diagnosed chronic kidney disease
Am J Kidney Dis
Retarding progression of chronic renal disease: the neglected issue of residual proteinuria
Kidney Int
Population-based screening for CKD
Am J Kidney Dis
Albuminuria and renal insufficiency prevalence guides population screening: results from the NHANES III
Kidney Int
CKD and cardiovascular disease in screened high-risk volunteer and general populations: the Kidney Early Evaluation Program (KEEP) and National Health and Nutrition Examination Survey (NHANES) 1999–2004
Am J Kidney Dis
The Kidney Early Evaluation Program (KEEP): program design and demographic characteristics of the population
Am J Kidney Dis
Strategies for national health care systems in emerging countries: the case of screening and prevention of renal disease progression in Bolivia
Kidney Int Suppl
Chronic kidney disease as a global public health problem: approaches and initiatives—a position statement from Kidney Disease Improving Global Outcomes
Kidney Int
Reporting estimated GFR: a laboratory perspective
Am J Kidney Dis
When laboratories report estimated glomerular filtration rates in addition to serum creatinines, nephrology consults increase
Kidney Int
Blood-pressure control for renoprotection in patients with non-diabetic chronic renal disease (REIN-2): multicentre, randomised controlled trial
Lancet
Renal function and requirement for dialysis in chronic nephropathy patients on long-term ramipril: REIN follow-up trial
Lancet
Renoprotective properties of ACE-inhibition in non-diabetic nephropathies with non-nephrotic proteinuria
Lancet
Renal outcomes with telmisartan, ramipril, or both, in people at high vascular risk (the ONTARGET study): a multicentre, randomised, double-blind, controlled trial
Lancet
K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification
Am J Kidney Dis
National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification
Ann Intern Med
Guidelines for the management of chronic kidney disease
CMAJ
Early identification and management of chronic kidney disease: summary of NICE guidance
BMJ
Prediction of creatinine clearance from serum creatinine
Nephron
A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation
Ann Intern Med
Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate
Ann Intern Med
Staging of chronic kidney disease: time for a course correction
J Am Soc Nephrol
A new equation to estimate glomerular filtration rate
Ann Intern Med
The growing burden of chronic kidney disease in Pakistan
N Engl J Med
Prevalence of chronic kidney disease in the United States
JAMA
The epidemiology of adult chronic kidney disease in a population-based study in Iran: prevalence and associated risk factors
J Nephrol
International comparison of the relationship of chronic kidney disease prevalence and ESRD risk
J Am Soc Nephrol
Risk factors for end-stage renal disease: 25-year follow-up
Arch Intern Med
Prevalence of chronic kidney disease in the United States
JAMA
Predictors of new-onset kidney disease in a community-based population
JAMA
Risk factors for chronic kidney disease: a prospective study of 23,534 men and women in Washington County, Maryland
J Am Soc Nephrol
SCreening for Occult REnal Disease (SCORED): a simple prediction model for chronic kidney disease
Arch Intern Med
Chronic kidney disease in the developing world
N Engl J Med
How can we achieve global equity in provision of renal replacement therapy?
Bull World Health Organ
Environmental lead exposure and progression of chronic renal diseases in patients without diabetes
N Engl J Med
Chronic kidney disease as a risk factor for cardiovascular disease and all-cause mortality: a pooled analysis of community-based studies
J Am Soc Nephrol
Cited by (499)
Urinary biomarkers in kidney disease
2024, Clinica Chimica ActaGreat potential of renal progenitor cells in kidney: From the development to clinic
2024, Experimental Cell ResearchNrf2/HO-1 as a therapeutic target in renal fibrosis
2023, Life Sciences