National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification

Article Abstract:

Chronic kidney disease is a worldwide public health problem with an increasing incidence and prevalence, poor outcomes, and high cost. Outcomes of chronic kidney disease include not only kidney failure but also complications of decreased kidney function and cardiovascular disease. Current evidence suggests that some of these adverse outcomes can be prevented or delayed by early detection and treatment. Unfortunately, chronic kidney disease is underdiagnosed and undertreated, in part as a result of lack of agreement on a definition and classification of its stages of progression. Recent clinical practice guidelines by the National Kidney Foundation 1) define chronic kidney disease and classify its stages, regardless of underlying cause, 2) evaluate laboratory measurements for the clinical assessment of kidney disease, 3) associate the level of kidney function with complications of chronic kidney disease, and 4) stratify the risk for loss of kidney function and development of cardiovascular disease. The guidelines were developed by using an approach based on the procedure outlined by the Agency for Healthcare Research and Quality. This paper presents the definition and five-stage classification system of chronic kidney disease and summarizes the major recommendations on early detection in adults. Recommendations include identifying persons at increased risk (those with diabetes, those with hypertension, those with a family history of chronic kidney disease, those older than 60 years of age, or those with U.S. racial or ethnic minority status), detecting kidney damage by measuring the albumin-creatinine ratio in untimed ("spot") urine specimens, and estimating the glomerular filtration rate from serum creatinine measurements by using prediction equations. Because of the high prevalence of early stages of chronic kidney disease in the general population (approximately 11% of adults), this information is particularly important for general internists and specialists.

Care and treatment, Practice guidelines (Medicine), Kidney diseases, Author Abstract

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Antilymphocyte antibodies, renal transplantation, and meta-analysis

Article Abstract:

Computer programs are needed to allow physicians to easily combine data from different clinical trials, a technique called meta-analysis. A group of researchers published two papers on the use of antilymphocyte antibodies to prevent graft rejection in kidney transplant recipients. One paper analyzed group data from clinical trials and the other analyzed individual patient data provided by physicians. Individual-patient meta-analysis revealed several facts about the treatment that had not been detected by the group-data meta-analysis. However, individual-patient meta-analysis is complicated and expensive, and needs to be simplified.

Editorial, Methods, Graft rejection, Meta-analysis, Immunotherapy

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Effect of angiotensin-converting enzyme inhibitors on the progression of nondiabetic renal disease: a meta-analysis of randomized trials

Article Abstract:

Fewer patients with non-diabetic kidney disease taking angiotensin-converting enzyme (ACE) inhibitors appear to develop life-threatening kidney complications compared to those taking other medications to lower blood pressure. Of 1,594 patients in 10 studies, 6.4% taking ACE inhibitors and 9.1% taking other medications developed kidney failure. Two percent of those taking ACE inhibitors and 1.5% of those taking other medications died. Patients taking ACE inhibitors had greater decreases in blood pressure than those taking other medications.

ACE inhibitors, Angiotensin converting enzyme inhibitors, Chronic kidney failure

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