Clinical Practice Guidelines in Nephrology
Clinical Practice Guidelines in Nephrology
The National Kidney Foundation developed and oversees the Kidney Disease Outcomes Quality Initiative, a process that develops clinical practice guide-lines in nephrology. Recent guidelines address the evaluation, classification, and stratification of chronic kidney disease (CKD). These guidelines provide, for the first time, a standard definition of CKD, classification of its stages, and suggestions for appropriate laboratory measurements for the assessment of kidney function. Also discussed are the association of level of kidney function with systemic complications that develop during CKD, and the risk of loss of kidney function and development of cardiovascular disease in CKD.
The first article in this series provided a general overview of the Kidney Disease Outcomes Quality Initiative (K/DOQI), a process developed and overseen by the National Kidney Foundation (NKF). That article described the methods used in development of the sequence of clinical practice guidelines (CPGs) and alluded to some of the outcomes associated with their widespread adoption within nephrology communities in the United States and throughout the world.
In the current article, we review aspects of what is perhaps the pivotal set of CPGs and emphasize those that are of particular importance to pharmacy practice. These CPGs address the evaluation, classification, and stratification of chronic kidney disease (CKD). These guidelines are especially far reaching, since they provide, for the first time, a standard definition of CKD, classification of its stages irrespective of under-lying cause, and suggestions for appropriate laboratory measurements for assessing kidney function. Further, the CPGs associate the level of kidney function with systemic complications that develop during CKD, and stratify the risk of loss of kidney function and development of cardio-vascular disease in CKD. Finally, they propose a clinical action plan for each stage of disease. Our focus is on the recommendations for adults; we refer the reader interested in recommendations for children to the original CPGs.
Abstract and Introduction
Abstract
The National Kidney Foundation developed and oversees the Kidney Disease Outcomes Quality Initiative, a process that develops clinical practice guide-lines in nephrology. Recent guidelines address the evaluation, classification, and stratification of chronic kidney disease (CKD). These guidelines provide, for the first time, a standard definition of CKD, classification of its stages, and suggestions for appropriate laboratory measurements for the assessment of kidney function. Also discussed are the association of level of kidney function with systemic complications that develop during CKD, and the risk of loss of kidney function and development of cardiovascular disease in CKD.
Introduction
The first article in this series provided a general overview of the Kidney Disease Outcomes Quality Initiative (K/DOQI), a process developed and overseen by the National Kidney Foundation (NKF). That article described the methods used in development of the sequence of clinical practice guidelines (CPGs) and alluded to some of the outcomes associated with their widespread adoption within nephrology communities in the United States and throughout the world.
In the current article, we review aspects of what is perhaps the pivotal set of CPGs and emphasize those that are of particular importance to pharmacy practice. These CPGs address the evaluation, classification, and stratification of chronic kidney disease (CKD). These guidelines are especially far reaching, since they provide, for the first time, a standard definition of CKD, classification of its stages irrespective of under-lying cause, and suggestions for appropriate laboratory measurements for assessing kidney function. Further, the CPGs associate the level of kidney function with systemic complications that develop during CKD, and stratify the risk of loss of kidney function and development of cardio-vascular disease in CKD. Finally, they propose a clinical action plan for each stage of disease. Our focus is on the recommendations for adults; we refer the reader interested in recommendations for children to the original CPGs.
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