Glassock_THE NKF-KDOQI (2002) CKD DEFINITION AND.ppt

8/16/2019 Glassock_THE NKF-KDOQI (2002) CKD DEFINITION AND.ppt

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THE NKF-KDOQI (2002) CKDDEFINITION AND

CLASSIFICATION SYSTEM:Limitations and Problems

Richard J. Glassock, MD, MACP

David Geffen S!""# "f Mediine a$ %CLA

KDIGO C"n$&"ve&'ie' C"nfe&eneL"nd"n %K

O$"e& * 200+


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A C"n$&a&ian' La,en$


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“A critic is a man wholeaves no turn

unstoned

Geor!e "ernard #haw New York Times

November 5, 1950


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KDOQI-CKD (2002): $ri!inal %ntent

De&ine !&"ni idne. di'ea'e (CKD) and $"#a''if. i$' '$a/e' i&&e'e$ive "f 1nde.in/di'ea'e

'valuate #a"&a$"&. ,ea'1&e,en$' f"& $!ea''e'',en$ "f idne. di'ea'e

Associate $!e #eve# "f idne. f1n$i"n i$!",#ia$i"n' "f CKD

S$&a$if. $!e &i' "f #"'' "f idne. f1n$i"n (ES3D)and deve#",en$ "f a&di"va'1#a& di'ea'e (C4D)and "$!e& ",#ia$i"n' "f CKD


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$ri!inal %ntent :C#a''ifia$i"n '.'$e, a' $"

e a#ied (unmodi&ied ) $""$! "1#a$i"n ana#.'i'and $" individ1a# a$ien$

,ana/e,en$


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C!&"ni Kidne. Di'ea'e (CKD):Classi&ication()*+(+-D$%(/00/1

S$a/e Kidne. eGF35

Da,a/e

(,#6,in6789,2)

7 ; 230 2 ; 40(53

*A 60(73

* *A 87(/3

< *A


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"ene&its)Real and Perceived1

"rou!ht order to the chaos "f n"'"#"/. "f CKD

%ncreased awareness "f $!e 1#i !ea#$!B&"#e, "f CKD in $!e /ene&a# "1#a$i"n and in

/ene&a# !.'iian'

Galvani9ed research (#inia# a'ieide,i"#"/ia#) "n $!e i''1e "f CKD

#timulated interest in earl: detection ("1#a$i"n and $a&/e$ed '&eenin/) "f CKD

Minimi9ed 1n$i,e#. '$a&$ "f dia#.'i'


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C!&"ni Kidne. Di'ea'e:Citations in PubMed; 8335(/005


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KDOQI-CKD (2002) C#a''ifia$i"n- Conse=uences o& its Pit&alls

$verestimated $!e /#"a# '"ie$a#1&den "f CKD (S$a/e' 7-*)

Gene&a$ed ,an. unnecessar: &efe&&a#'

f&", F6G $" Ne!&"#"/. (fa#'e-"'i$ive dia/n"'i' "f CKD)- #eadin/ $"anie$.6een'e

&","$ed screenin! f"& CKD (de &actoand overt ) 1'in/ eGF3

&","$ed eGF3-defined CKD a' a surro!ate f"& C4D and ES3D &i'i$!"1$ "n'ide&a$i"n "f &"#e "fa#1,in1&ia


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CKD &eva#ene-%SA:*>A*'# )+D$%("ased;8333(/00?1

(C"&e'! e$ a# AMA 2009)

S$a/e &eva#ene &eva#ene() ( 70H)

7 789 8 2 82* 8< 98+ 7


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CKD-NHANESPrevalence o& C+D )+D$%1 #ta!e 6 b: A!e

(7+++-200*)

KD T


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KD &eva ene T&en ': eGR )creatinine1 v eGR )c:statin C1

(7+-7++* v' 7+++-2002 NHANES> F"#e. 3 e$ a# CASN *:+


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A/in/ and GF3


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CKD


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CKD: eGR in “>ealth: Caucasians

b: Gender

2et;els,< et al=Ni>meen ?iomedical @t!dy, )00A4

3ales Females

95t# Bercentile

50t# Bercentile

5t# Bercentile

CKD &eva#ene: +aiser Permanente


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CKD &eva#ene: +aiser(Permanente A!e-Microalbuminuria(Adusted and

#tandard KDOQI C&i$e&ia(31$"'i e$ a# AKD 200+> C"&e'! e$ a# AMA 200)


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eGF3 (MD3D): Precision and "ias


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eGF3 (MD3D) v' ,GF3 (Cin))"otev, et al, CJA#*, /0031


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&ei'i"n and Jia': eGR )MDRD1 vs mGR )Cin1(J"$ev 3 e$ a# CASN *:++-+0 200+)

oncor ance " a/e "& n/


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oncor ance " a/e "& n/$" ,GF3 (Ced$a) and eGF3 (MD3D4

(F&"i''a&$ e$ a#8 ASN 200 7++< i$! CKD672 n"&,a# d"n"&')

mGF @tae

1

@tae

)

@tae

(

@tae

@tae

5

$90 4B ()C 0&+C 0 0

+0A9 1+C 4?B )1C 0&)C 0

(059 0&5C 1)C 5B 10C 0

15)9 0 0 1'C 3B &)C

*15 0 0 (&1C ()C 47B


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eGF3 and Dia/n"'i' "f CKD: An %llustration

A 2< .ea& "#d ,an i$! an eGF3 "f 77 ,#6,in6789,2 i' *A# #%G*%iCA*@ C+DE


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CKD and C",#ia$i"n': Cardiovascular Disease

)CFD1

C+D CFD;


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C+D(CFD; Adusted >R &or All(Cause Mortalit: and CF

'vents)Go et al, *'JM1

eGF3 and M"&$a#i$. 3i' in $!e


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eGF3 and M"&$a#i$. 3i' in $!eE#de.: $ver 0 :ears o& a!e

)PR$#P'R nH750?1(F"&d I e$ a# L"S Med :9 200+)


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A##-Ca1'e M"&$a#i$. and eGF3 @aiwan >ealth Mana!ement %nstitution #tud:

) ?4/,/36 Ad1#$'-N" an"&,a# &"$ein1&ia 1 (en C e$ a#8 T!e Lane$ 97:279 200)

A## C M $ #i$ d $ i i


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A##-Ca1'e M"&$a#i$. and &"$ein1&ia)At same eGR strata1

@aiwan >ealth Mana!ement %nstitution #tud: Lancet /005

CKD S$a/e


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CKD S$a/e Risk o& Cardiovascular Disease

(J&an$',a AH e$ a# and 3E4END8 NDT 200)(n?*+


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C4D even$' and CKD:PR'F'*D #tud:

(van de& 4e#de M e$ a#8 ASN 200)


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CKD and C",#ia$i"n': Pro!ression to '#RD

T!e H%NT-II S$1d.-


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T!e H%NT-II S$1d.- Ad1'$ed 70 .ea& &i' "f ES3D a"&din/ $"

eGF3 and A#1,in1&ia(Ha##an S e$ a# ASN 20:70+-7099 200+)


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!a$ i' CKDB

I' i$ a Dia!nosis--- F"& a "1#a$i"n "& anindivid1a#

I' i$ a Post(dia!nostic '$e $" !rade $!e'eve&i$. and de$e&,ine $!e &i'' "f&"/&e''i"n "& ",#ia$i"n'

I' i$ a non(s


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I$ "1/!$ $" e &e,e,e&ed $!a$$!e&e i' n"$!in/ ,"&e diffi1#$ $" $aein !and ,"&e e&i#"1' $" "nd1$ "&

,"&e 1ne&$ain in i$' '1e'' $!an $"$ae $!e #ead in $!e in$&"d1$i"n "f a

ne "&de& "f $!in/'B

*iccolo Machiavelli( @he Prince, 8786


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Glassock_THE NKF-KDOQI (2002) CKD DEFINITION AND.ppt