Blog entry by Meguid El Nahas
A debate has been ongoing for a number of years between those who support the KDOQI (2002) and more recently KDIGO (2012) CKD classification and those who argue that the whole concept has considerable shortcomings and flaws:
Main arguments for current classification:
1. Clinically useful
2. Prognostically relevant as eGFR and albuminuria not only reflect ESRD prognosis but also CVD and all cause mortality outcomes
3. Increased CKD awareness
4. Highlights the true scale of the CKD problem worldwide
Main arguments against:
1. Epidemiologically useful but less so clinically
2. Adds little to conventional prognosis markers such as severity of proteinuria, serum creatinine level at presentation and old fashion 1/sCr slope and/or conventional cardiovascular prediction scores such as Framingham Risk Score.
3. Flawed risk prediction analysis lacking validity and usefulness:
4. Microalbuminuria is not sufficient on its own to define CKD 1 or 2.
5. Artificial and clinically irrelevant division of CKD1 and 2 in the absence of the known difference in natural history of CKD 1 versus 2.
6. Overestimation of CKD, as it is epidemiologically primary a fact that up to 30-40% of those >65 years of age have a "physiological" decline in GFR. Lack of age consideration in the classification. (http://www.ncbi.nlm.nih.gov/pubmed/22437416)
7. Scare mongering of an "epidemic' of CKD based on flawed epidemiological studies
also see lecture on OLA given at the World Congress of Nephrology:
Recent controversy between two extremely knowlegeable and respected camps in this field was highlighted by respective articles in
Clin Chem Lab Med July 2013 by:
Delanaye and Cavalier: http://www.ncbi.nlm.nih.gov/pubmed/23729625
arguing against the status quo
Zoccali and colleagues arguing for the status Quo:
OLA and the Global Kidney Academy encourages a debate on this very important issue in Nephrology.
Taking sides may be unhelpful but more importantly comments are welcomed from practicing Nephrologists on, after evaluating the arguments above:
1. Whether a division between CKD 1 and 2 is justifiable?
2. eGFR and Albuminuria are unique predictors of outcomes in CKD thus justifying their inclusion in classification (KDIGO 2012)
3. Whether Age is irrelevant to classification so should not be taken into consideration?
We need to hear the voice and opinion of Practicing Nephrologists Worldwide!