A Critique of Clinical Guidelines for Detection of Individuals with Chronic Kidney Disease

Chronic kidney disease (CKD) and its association with cardiovascular mortality is increasingly regarded as a global public health problem. International efforts to combat this 'epidemic' have led to fundamental changes not only in the way we measure renal function but also how we classify and manage CKD. Clinical guidelines have established the use of estimated glomerular filtration rate (eGFR) and Kidney Disease Outcomes Quality Initiative classification of kidney disease as the cornerstones of CKD detection. The introduction of these guidelines in routine practice has had considerable impact on the large number of patients newly labelled with a chronic disease. However, it is far from clear that these patients with low GFR have intrinsic kidney disease and the vast majority will not develop end-stage renal failure. Furthermore, there is a lack of evidence that identification of low GFR can usefully be used to screen populations either for metabolic complications of kidney disease or cardiovascular risk. Copyright (C) 2008 S. Karger AG, Basel