Blog entry by Arif Khwaja
Anyone in the world
The KDIGO 2012 CKD guidelines which were recently published are available for all to read. Here are my immediate thoughts:
i) There are 2 chapters on defining and identifying CKD and progression and only one chapter on the management of progression of CKD and its complications. This tells you all you need to know about the obssession with epidemiological data in the nephrology literature at the moment. This is true of not only CKD but AKI as well
ii) Worth reminding ourselves that there is not one single licensed therapy for preventing the progression of CKD - its disappointing that of all the research recommendations made not one focussed on the need for licensed therapies in progressive CKD and how to collaborate with industry/academia to deliver this
iii) The classification system is absurdly complex and is a great example of the dangers of taking an epidemiologically useful tool for research and putting it into the clinical arena. I gave a talk to some family doctors last week and went over the KDIGO classification system... all of them found it confusing, complex and nobody could understand why there needed to be another revision of the staging system. One of the doctors just looked at the classification and said " that just gives me a headache".....
iv) has anybody met a busy practicing nephrologist who thinks that microalbuminuria should be considered as a sole definer of CKD?
v) Can anyone explain how differentiating between CKD 1 and 2 based on current eGFR equations a) makes sense and b) will change patient management and improve outcomes
vi) as discussed the age neutrality of the classification simply does not stand up to any scrutiny... we all know that an eGFR of 40mls/min means different things in a 20 year old and a 70 year old as was powerfully shown by O'Hare and colleagues several years ago
vii) I have yet to see a convincing rebuttal to the critique of the CKD classification system put forward by the likes of Glassock and Winnearls and others several years ago
vii) KDIGO either needs to remove the term 'Global' from its title or start addressing the healthcare needs of the global population. The earlier guidelines on transplantation did discuss models of care in low income countries yet here there is no such discussion here. Its great to talk about patient activation, psychosocial support and the need for conservative care for those of us who work in affluent societies. Yet we know large swathes of the global population have no access to any kind of nephrology care. To provide absolutely no discussion or direction for how low/middle income societies should deal with CKD at best displays a lack of imagination and at worst just highlights the academic and geographical myopia of those who wrote guidelines.
[ Modified: Thursday, 1 January 1970, 1:00 AM ]