BACKGROUND: Using both estimated glomerular filtration rate (eGFR) and proteinuria to classify the severity of chronic kidney disease (CKD) has been proposed. The utility of a staging system incorporating both eGFR and proteinuria for guiding the evaluation of concurrent CKD complications is not known. STUDY DESIGN: Cross-sectional analysis. SETTING & PARTICIPANTS: 30,528 participants in the US National Health and Nutrition Examination Survey conducted in 1988-1994 and 1999-2006 (n = 8,242 for hyperparathyroidism). PREDICTORS: Classification system that uses both eGFR and proteinuria (alternative) and a system that primarily uses eGFR (NKF-KDOQI [National Kidney Foundation's Kidney Disease Outcomes Quality Initiative]). OUTCOMES: Prevalence of anemia, acidosis, hyperphosphatemia, hypoalbuminemia, hyperparathyroidism, and hypertension. MEASUREMENTS: GFR estimated from the CKD Epidemiology Collaboration (CKD-EPI) equation and proteinuria assessed using urine albumin-creatinine ratio. RESULTS: Prevalences of hypoalbuminemia, hypertension, and hyperparathyroidism increased with more severe CKD using the NKF-KDOQI system. For example, the prevalence of hyperparathyroidism was 9.1%, 11.1%, 28.2%, and 72.5% for stages 1, 2, 3 and 4, respectively. Similarly, prevalences of anemia, acidosis, and hyperphosphatemia increased progressively from stage 2 through 4. With the alternative system, prevalences of anemia, hyperphosphatemia, hypertension, and hyperparathyroidism were lower in stage 3 than in stage 2. For example, the prevalence of hyperparathyroidism was 13.5%, 40.3%, 22.2%, and 63.4% for stages 1, 2, 3 and 4, respectively. Applying the alternative system, participants without each complication were more likely to be reclassified appropriately to lower stages (eg, overall net reclassification index of -6.5% for hyperparathyroidism). However, participants with complications (except for hypoalbuminemia) were more likely to be reclassified inappropriately to lower stages. LIMITATIONS: Use of a single creatinine measurement to estimate GFR and single measurement to assess albumin-creatinine ratio. Small number of participants with CKD stage 4. CONCLUSIONS: The NKF-KDOQI system may better identify patients with certain concurrent CKD complications compared with systems using eGFR and proteinuria. Copyright Â
BACKGROUND: Using both estimated glomerular filtration rate (eGFR) and proteinuria to classify the severity of chronic kidney disease (CKD) has been proposed. The utility of a staging system incorporating both eGFR and proteinuria for guiding the evaluation of concurrent CKD complications is not known. STUDY DESIGN: Cross-sectional analysis. SETTING & PARTICIPANTS: 30,528 participants in the US National Health and Nutrition Examination Survey conducted in 1988-1994 and 1999-2006 (n = 8,242 for hyperparathyroidism). PREDICTORS: Classification system that uses both eGFR and proteinuria (alternative) and a system that primarily uses eGFR (NKF-KDOQI [National Kidney Foundation's Kidney Disease Outcomes Quality Initiative]). OUTCOMES: Prevalence of anemia, acidosis, hyperphosphatemia, hypoalbuminemia, hyperparathyroidism, and hypertension. MEASUREMENTS: GFR estimated from the CKD Epidemiology Collaboration (CKD-EPI) equation and proteinuria assessed using urine albumin-creatinine ratio. RESULTS: Prevalences of hypoalbuminemia, hypertension, and hyperparathyroidism increased with more severe CKD using the NKF-KDOQI system. For example, the prevalence of hyperparathyroidism was 9.1%, 11.1%, 28.2%, and 72.5% for stages 1, 2, 3 and 4, respectively. Similarly, prevalences of anemia, acidosis, and hyperphosphatemia increased progressively from stage 2 through 4. With the alternative system, prevalences of anemia, hyperphosphatemia, hypertension, and hyperparathyroidism were lower in stage 3 than in stage 2. For example, the prevalence of hyperparathyroidism was 13.5%, 40.3%, 22.2%, and 63.4% for stages 1, 2, 3 and 4, respectively. Applying the alternative system, participants without each complication were more likely to be reclassified appropriately to lower stages (eg, overall net reclassification index of -6.5% for hyperparathyroidism). However, participants with complications (except for hypoalbuminemia) were more likely to be reclassified inappropriately to lower stages. LIMITATIONS: Use of a single creatinine measurement to estimate GFR and single measurement to assess albumin-creatinine ratio. Small number of participants with CKD stage 4. CONCLUSIONS: The NKF-KDOQI system may better identify patients with certain concurrent CKD complications compared with systems using eGFR and proteinuria. Copyright Â
Authors: Ron T Gansevoort; Kunihiro Matsushita; Marije van der Velde; Brad C Astor; Mark Woodward; Andrew S Levey; Paul E de Jong; Josef Coresh Journal: Kidney Int Date: 2011-02-02 Impact factor: 10.612
Authors: Marcello Tonelli; Paul Muntner; Anita Lloyd; Braden J Manns; Matthew T James; Scott Klarenbach; Robert R Quinn; Natasha Wiebe; Brenda R Hemmelgarn Journal: Ann Intern Med Date: 2011-01-04 Impact factor: 25.391
Authors: Andrew S Levey; Paul E de Jong; Josef Coresh; Meguid El Nahas; Brad C Astor; Kunihiro Matsushita; Ron T Gansevoort; Bertram L Kasiske; Kai-Uwe Eckardt Journal: Kidney Int Date: 2010-12-08 Impact factor: 10.612
Authors: Vandana Menon; Hocine Tighiouart; Nubia Smith Vaughn; Gerald J Beck; John W Kusek; Allan J Collins; Tom Greene; Mark J Sarnak Journal: Am J Kidney Dis Date: 2010-06-03 Impact factor: 8.860
Authors: Marije van der Velde; Kunihiro Matsushita; Josef Coresh; Brad C Astor; Mark Woodward; Andrew Levey; Paul de Jong; Ron T Gansevoort; Marije van der Velde; Kunihiro Matsushita; Josef Coresh; Brad C Astor; Mark Woodward; Andrew S Levey; Paul E de Jong; Ron T Gansevoort; Andrew Levey; Meguid El-Nahas; Kai-Uwe Eckardt; Bertram L Kasiske; Toshiharu Ninomiya; John Chalmers; Stephen Macmahon; Marcello Tonelli; Brenda Hemmelgarn; Frank Sacks; Gary Curhan; Allan J Collins; Suying Li; Shu-Cheng Chen; K P Hawaii Cohort; Brian J Lee; Areef Ishani; James Neaton; Ken Svendsen; Johannes F E Mann; Salim Yusuf; Koon K Teo; Peggy Gao; Robert G Nelson; William C Knowler; Henk J Bilo; Hanneke Joosten; Nanno Kleefstra; K H Groenier; Priscilla Auguste; Kasper Veldhuis; Yaping Wang; Laura Camarata; Beverly Thomas; Tom Manley Journal: Kidney Int Date: 2011-02-09 Impact factor: 10.612