We searched the Cochrane Library, Medline, and Embase up to the end of August, 2009, with the search terms “chronic kidney disease” or “chronic renal insufficiency” in combination with “diagnosis”, “screening”, “prevention”, “control”, “treatment”, or “intervention”. Largely, we selected publications from the past 10 years from journals with high impact factors but did not exclude frequently referenced and highly regarded older publications. We also searched the reference lists of
SeriesEarly recognition and prevention of chronic kidney disease
Introduction
Chronic kidney disease is a common disorder that is associated with raised risk of cardiovascular disease, kidney failure, and other complications. The ageing of populations along with the growing global prevalence of diabetes and other chronic non-communicable diseases has led to corresponding worldwide increases in prevalence of chronic kidney disease and kidney failure. Strategies for early identification and treatment of people with chronic kidney disease, who are at risk of cardiovascular events and progression to the end stage of chronic kidney disease (kidney failure), are needed worldwide, especially in countries where renal replacement is not readily available. This Review will discuss potential strategies for early identification and treatment of such high-risk patients to reduce morbidity and mortality associated with later stages of chronic kidney disease.
Section snippets
Definition, classification, and staging
Chronic kidney disease is defined by a sustained reduction in glomerular filtration rate or evidence of structural or functional abnormalities of the kidneys on urinalysis, biopsy, or imaging.1, 2, 3 A five-stage classification system for the disorder has been established by the US National Kidney Foundation's Kidney Disease Outcomes Quality Initiative and adopted internationally by the Kidney Disease: Improving Global Outcomes (KDIGO) initiative to guide identification of cases and facilitate
Epidemiology
The prevalence of chronic kidney disease has been estimated in several developed countries but remains unknown in much of the developing world.15 Adoption of standard definitions and use of the MDRD study equation for estimated glomerular filtration rate have facilitated international comparisons. When chronic kidney disease is defined solely by estimated glomerular filtration rates less than 60 mL per min 1·73 m2, approximate prevalence is 2·5–11·2% of the adult population across Europe, Asia,
Strategies for early recognition
Early identification of patients with chronic kidney disease is desirable because interventions can then be implemented to reduce risk of cardiovascular events or progression to kidney failure. The high prevalence of chronic kidney disease,15 absence of symptoms until disease is advanced, accessibility of laboratory tests for diagnosis and prognostication,51 and availability of treatments that prevent complications suggest that screening for chronic kidney disease could be worthwhile. However,
Prevention and intervention
Initial management of chronic kidney disease entails identification of reversible disorders (such as urinary-tract obstruction, infection, or autoimmune disease) that could respond to specific treatment and lead to stabilisation or improvement in kidney function. Irrespective of underlying cause, typical goals of management for all patients with chronic kidney disease include prevention of cardiovascular events and reduction of the rate of progression of the disorder (thereby delaying or
Further challenges and directions
Better clinical methods are needed to distinguish patients at risk of adverse renal and cardiovascular outcomes to permit best use of resources. The use of predictive techniques that combine estimated glomerular filtration rate and proteinuria might represent one such potential advance. Novel biomarkers could help to identify individuals at risk of progressive chronic kidney disease and kidney failure in the future. Although effective interventions to slow the progression of diabetic and
Search strategy and selection criteria
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