1. Canadian Society of Nephrology commentary on the KDIGO clinical practice guideline for CKD evaluation and management
- Author
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Paul Komenda, François Madore, Braden J. Manns, Sara Mahdavi, Aminu K. Bello, Reem A. Mustafa, Patrick Feltmate, Catherine M. Clase, Andrew Smyth, Ayub Akbari, Allan Grill, Meena Karsanji, E. Sohani Welcher, Phil Acott, and Marisa Battistella
- Subjects
Nephrology ,medicine.medical_specialty ,Canada ,medicine.medical_treatment ,Kidney Disease: Improving Global Outcomes (KDIGO) ,Renal function ,urologic and male genital diseases ,albuminuria ,Internal medicine ,Diabetes mellitus ,Medicine ,Humans ,Renal Insufficiency, Chronic ,Intensive care medicine ,Dialysis ,Societies, Medical ,Body surface area ,urogenital system ,business.industry ,kidney disease progression ,Disease Management ,Guideline ,medicine.disease ,female genital diseases and pregnancy complications ,Canadian Society of Nephrology (CSN) ,Treatment Outcome ,chronic kidney disease (CKD) staging ,Practice Guidelines as Topic ,Estimated glomerular filtration rate (eGFR) ,Albuminuria ,medicine.symptom ,business ,clinical practice guideline ,Kidney disease - Abstract
We congratulate the KDIGO (Kidney Disease: Improving Global Outcomes) work group on their comprehensive work in a broad subject area and agreed with many of the recommendations in their clinical practice guideline on the evaluation and management of chronic kidney disease. We concur with the KDIGO definitions and classification of kidney disease and welcome the addition of albuminuria categories at all levels of glomerular filtration rate (GFR), the terminology of G categories rather than stages to describe level of GFR, the division of former stage 3 into new G categories 3a and 3b, and the addition of the underlying diagnosis. We agree with the use of the heat map to illustrate the relative contributions of low GFR and albuminuria to cardiovascular and renal risk, though we thought that the highest risk category was too broad, including as it does people at disparate levels of risk. We add an albuminuria category A4 for nephrotic-range proteinuria and D and T categories for patients on dialysis or with a functioning renal transplant. We recommend target blood pressure of 140/90mm Hg regardless of diabetes or proteinuria, and against the combination of angiotensin receptor blockers with angiotensin-converting enzyme inhibitors. We recommend against routine protein restriction. We concur on individualization of hemoglobin A1c targets. We do not agree with routine restriction of sodium intake to 3.3g/d). We suggest screening for anemia only when GFR is 60mg/mmol or proteinuria with protein excretion > 1g/d as the referral threshold for proteinuria.
- Published
- 2014