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Josef Coresh, Lesley A. Stevens, Andrew S. Levey, Chronic kidney disease is common: What do we do next?, Nephrology Dialysis Transplantation, Volume 23, Issue 4, April 2008, Pages 1122–1125, https://doi.org/10.1093/ndt/gfn117
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Introduction
Glassock and Winearls thoughtfully acknowledge some of the major gains made as a result of the standardized guidelines for the definition, evaluation, classification and stratification of chronic kidney disease (CKD) as well as point out a number of concerns [ 1 ]. We agree with the distinction between a clear epidemic rise in the number and rate of treated kidney failure [also known as end-stage renal disease (ESRD)] in the United States and other countries and much weaker data about trends in earlier stages of CKD. There is also high prevalence of earlier CKD stages 1–4 and a growing literature about associated consequences. We will briefly discuss trends in treated kidney failure, trends in earlier stages of CKD, the rationale for a single GFR cutoff for the definition of CKD, and our view of promising approaches for future research and practice in CKD. We recognize that population estimates of the full range of CKD (stages 1–5) result in dauntingly high numbers which are clearly beyond the scope of nephrologists alone. We think that the ability to make such estimates based on survey and clinical data provide important information to guide planning and to avoid thinking that all patients with CKD can or need to be seen by a nephrologist. Standardized definition and staging facilitates growth of the evidence base about prognosis and treatment that should be based not only on CKD stage, but also on the full clinical presentation, including, the cause of kidney disease, level of proteinuria, age, sex and race. It is likely that drug dosing and avoiding acute kidney injury from medications, contrast agents and procedures will largely depend on estimated GFR (eGFR) alone, but additional information will be needed for the prevention and treatment of different outcomes of CKD.
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