The pros and cons of staging chronic kidney disease

Abstract

Background and objectives: In 2002 the National Kidney Foundation Kidney Disease Outcomes Quality Initiative presented a new definition and classification for chronic kidney disease (CKD), which was revised in 2004 to the current CKD staging system. This significantly increased awareness and understanding of CKD-related issues and promoted the use of evidence-based clinical practice principles. Due to the wealth of knowledge that has been acquired, the accuracy and appropriateness of CKD staging system has now been questioned, prompting a timely and comprehensive evaluation of the current atmosphere surrounding CKD staging. Here, we discuss the benefits and limitations of the current CKD staging system and provide suggestions for improvement.

Methods: A review of journals in PubMed and other databases surrounding the issues of CKD staging was performed. A minimum of 40 reviews and original works were examined and the most significant articles were chosen for this review.

Results: Several important facts were highlighted. The prevalence of CKD has risen between the periods 1988-1994 and 1998-2004. There are numerous limitations to the estimated glomerular filtration fraction (eGFR) measure of renal function. Albuminuria, which impacts cardiovascular risk as well as CKD progression, should be combined with eGFR. The approach of adding albuminuria into staging has been shown in large scale studies to correlate more strongly with renal outcomes and optimally predict CKD prognosis. Recommendations for primary prevention, secondary prevention and tertiary prevention of CKD as well as appropriate referrals to a nephrologist were provided.

Conclusions: There is great support for revising the current CKD definition and classification system.