KDIGO Improving CKD Quality of Care - Scope of Work - Final
KDIGO Improving CKD Quality of Care - Scope of Work - Final
KDIGO Improving CKD Quality of Care - Scope of Work - Final
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of screening in high-risk populations combined with lack of patient symptoms, most
kidney disease remains undiagnosed and untreated until later stages, when
interventions are less effective.4,15, 16
The very first guideline for CKD published by the Kidney Disease Outcomes Quality
Initiative outlined the importance of identifying and staging CKD and emphasized the
need to improve CKD diagnosis with use of estimating equations that are not dependent
on serum creatinine alone.17 In 2009, KDIGO sponsored a controversies conference and
conducted a large meta-analysis of 45 cohorts that included over 1.5 million adults to
examine the association of estimated GFR and albuminuria with kidney outcomes and
mortality.18 This conference confirmed the existing definition of CKD but led to
modifying CKD classification by adding the urine albumin-to-creatinine ratio (UACR)
levels to each stage and subdividing CKD stage 3 into two stages, thus creating the
KDIGO “heat map.” The 2012 KDIGO CKD Guideline19 then promoted the use of the
KDIGO CKD heat map and a classification of CKD based on the dimensions of GFR,
albuminuria, and clinical diagnosis to determine patient status and prognosis. The 2012
KDIGO Guideline also encouraged use of the best GFR estimating equation validated in
the population of interest. In addition, rapid CKD progression was defined as a sustained
decline in GFR of greater than 5 ml/min/1.73 m2, and the guideline provided guidance
for managing CKD progression and its complications. Patient safety and timing of
nephrology referral were also discussed.
In the ten years since the last KDIGO CKD Guideline was published, tremendous
increases in both knowledge and tools for CKD identification and management have
facilitated the expansion of CKD care and its precision and quality. New drugs, such as
the sodium glucose co-transporter 2 inhibitors, have shown effectiveness in delaying or
even preventing kidney failure and cardiovascular disease events in high-risk patients.
Unfortunately, due to cost, these drugs are not available to all who may benefit, and
CKD continues to be poorly recognized, even within high-risk populations. Research has
led to the identification of new biomarkers that may add precision to kidney disease
diagnosis, but uncertainty continues regarding how to implement these biomarkers into
clinical practice for the staging and prognostication of CKD and the potential gains for
patients with their use. Novel imaging methods could potentially alleviate the need for
kidney biopsy, and artificial intelligence and learning health systems have emerged as
new ways to identify patients at high risk for kidney disease and its complications and
facilitate implementation of interventions in a timely fashion. Novel technologies have
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the potential to improve the identification of CKD etiologies in individual patients and
assess dominant pathomechanisms. While innovation in nephrology care is exciting, the
translation of such programs into clinical practice routines will require a paradigm shift
in nephrology care and an ongoing discussion of the potential implications to care
delivery. The last ten years has also heightened the importance of the patient voice
when identifying gaps in research and clinical strategies that will not only prevent CKD
progression and its complications, but foremost improve the quality of life for an
individual living with kidney disease.
CONFERENCE OVERVIEW
This 2022 CKD Controversies Conference will examine and discuss best practices for
improving the precision of CKD diagnosis and prognosis, managing the complications of
CKD, enhancing the safety of care, and maximizing patient quality of life. Much attention
has been centered on the role of GFR and albuminuria in CKD management, while there
has been less emphasis on the cause of CKD. This forward-looking conference intends to
revisit the importance of accurate CKD diagnosis as well as how current concepts about
disease variability and treatment heterogeneity may improve prognostication and
identification of proper treatments and enhance the quality of care. To determine best
clinical practices and identify research needs, many questions related to the
identification, staging, and clinical care of patients with CKD must be addressed. Novel
methods for assessing the diagnosis and prognosis of CKD, such as use of novel imaging
methods, utilization of urine as a liquid biopsy, and the potential of new biomarkers of
kidney function and damage, will be considered. The conference will also emphasize the
broad health impact of CKD with a number of CKD-associated complications beyond loss
of kidney function and cardiovascular disease. Discussion will include best practices for
assessing patient reported outcomes to maximize quality of life and for mitigating
polypharmacy while maximizing patient safety.
Drs. Kai-Uwe Eckardt (Charité Berlin, Germany) and Holly Kramer (Loyola University
Chicago, USA) will co-chair this conference. The format of the conference will involve
topical plenary session presentations followed by focused discussion groups that will
report back to the full group for consensus building. This highly interactive conference
will invite key thought leaders and relevant stakeholders, including patients, who will
comprehensively review the literature and current state of understanding in this area
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and address clinical issues as outlined in the Appendix: Scope of Coverage. The
conference output will include publication of a position statement guiding CKD
management and future research and will inform current efforts for updating the 2012
CKD guideline.
Group 3: Polypharmacy
References
1. GBD Chronic Kidney Disease Collaboration. Global, regional, and national burden
of chronic kidney disease, 1990-2017: a systematic analysis for the Global
Burden of Disease. Study 2017. Lancet. 2020; 395:709-733.
4. Luyckx VA, Tonelli M, Staniferc JW. The global burden of kidney disease and the
sustainable development goals. Bull World Health Organ. 2018; 96:414–422C.
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Collaborators. Global, regional, and national disability-adjusted life-years (DALYs)
for 315 diseases and injuries and healthy life expectancy (HALE), 1990-2015: a
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Data Report: Epidemiology of Kidney Disease in the United States. Am J Kidney
Dis. 2021; 77(4 Suppl 1):A7-A8.
16. Centers for Disease Control and Prevention Chronic Kidney Disease Surveillance
System—United States. Available from: Accessed May 6, 2022.
17. National Kidney Foundation. K/DOQI Clinical Practice Guidelines for Chronic
Kidney Disease. Evaluation, Classification and Stratification. Am J Kidney Dis.
2002; 39(Suppl 1): S1-S266.
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chronic kidney disease: A KDIGO Controversies Conference Report. Kidney Int.
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19. KDIGO 2012 Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work
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