Early detection of CKD: the benefits, limitations and effects on prognosis

Abstract

The past decade has seen an increasing focus on chronic kidney disease (CKD) and its attendant complications, which has resulted in improved understanding of their impact on health-care resources. The early detection of CKD has been facilitated by the implementation of routine reporting of estimated glomerular filtration rates (eGFRs) and by education of primary care physicians on the implications of detecting a decreased eGFR with respect to patient safety as well as to cardiovascular and renal outcomes. The goals of early CKD detection are to prevent CKD progression and associated complications, thus improving patient outcomes and reducing the impact of CKD on health-care resources. This Review examines the benefits of the early detection of CKD, and describes the limitations of current knowledge with respect to screening, early detection and treatment, as well as the unintended consequences of detection. In addition, this article highlights what is currently known about cardiovascular and renal outcomes and the effects of intervention in patients with CKD.

Recovery from AKI in the critically ill: potential confounders in the evaluation

“…Reliable data on AKI recovery have significant implications for planning nephrological follow-up [40][41][42], for comparative research, and for power calculations in future intervention studies. Our analysis suggests that, in order to be comparable, reports on recovery from AKI should provide detailed data on the included population (inclusion or exclusion of non-survivors, proportion of CKD), on the definition and severity of AKI, on the definition used for and the timing of recovery assessment, and on the handling of missing baseline creatinine.…”

Identifying risk of progression for patients with Chronic Kidney Disease using clustering models

“…[3] Studies have also shown that "targeting people with stage 4 CKD for appropriate disease management adds value in terms of delayed progression of disease, and improved blood pressure control and CVD ("cardiovascular disease") risk management." [4] Thus, identifying CKD at an early stage may help physicians enhance the longer-term outcomes of these patients.…”

Normalisation of urinary biomarkers to creatinine for clinical practice and research – when and why

“…(2) While acute kidney injury (AKI) is a known risk factor for CKD progression, current methods of diagnosis, such as the measurement of serum creatinine, are unsatisfactory due to their delay in the diagnosis of kidney disease. (3) As serum creatinine is affected by filtration function, its rise reflects a significant, and often permanent, loss of functioning nephrons.…”