Meeting the challenges of the new K/DOQI guidelines.

Substantial gains in the dialytic treatment of patients with end-stage renal disease have been made during the past several decades. However, inadequate attention has been given to the problem of chronic kidney disease (CKD) as a whole. CKD and its associated complications emerge years before patients develop kidney failure and become dialysis dependent. It now is evident that to improve dialysis outcomes, it is essential for practitioners to recognize the earlier stages of CKD, not only to retard disease progression, but also to prevent and treat its complications and comorbidities long before the need for dialysis arises. The recently published National Kidney Foundation Kidney Disease Outcomes Quality Initiative guidelines identify the broad-based problem of CKD in the general population and introduce action plans that can be used at the different stages of CKD. This article discusses the process behind the development of the CKD guidelines and highlights the disease evaluation, classification, and stratification system provided by the guidelines. It is hoped that widespread implementation of these recommendations will increase the understanding of CKD among both providers and patients and eliminate many of the obstacles that nephrologists have faced in providing optimal care to dialysis patients in particular and to patients with CKD in general.