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Canadian Society of Nephrology commentary on the KDIGO clinical practice guideline for CKD evaluation and management
- Source :
- American journal of kidney diseases : the official journal of the National Kidney Foundation. 65(2)
- Publication Year :
- 2014
-
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.
- 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
Subjects
Details
- ISSN :
- 15236838
- Volume :
- 65
- Issue :
- 2
- Database :
- OpenAIRE
- Journal :
- American journal of kidney diseases : the official journal of the National Kidney Foundation
- Accession number :
- edsair.doi.dedup.....c4127ad3d67c8509081f980333665b9a