KDOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification


THE WORK GROUP thanks the National Kidney Foundation for support and guidance during this project. James Smith, Nadine Ferguson, Donna Fingerhut, and Kerry Willis, PhD, were instrumental in coordinating the project. The KDOQI Chairs and Advisory Board provided constructive criticism that helped shape the project. The KDOQI Support Group provided practical advice to facilitate implementation. Stefan Armstrong, consultant editor, provided invaluable assistance in preparing the report.

The Work Group is indebted to the Evidence Review Team, who worked tirelessly to assemble the evidence and creatively to synthesize the information.

The Work Group appreciates the careful review of the draft guidelines and suggestions for improvement by external reviewers. Each comment was carefully considered and, whenever possible, suggestions for change were incorporated into the final report. As a result, the CKD guidelines are the product of the Work Group, the Evidence Review Team, the NKF, and all those who contributed their effort to make the Guidelines better.

The following individuals provided written review of the draft guidelines: Hernan Aguirre, MD; Suhail Ahmad, MD; Pedro Aljama, MD; Jane Allen, FNPC; Sanford D. Altman, MD; Theresa M. Ambrose, PhD; Lawrence J. Appel, MD; Yoshinori Araki; Teri Arthur, MSW, CSW, LSW; Carolyn L. Atkins, RN, BS, CCTC; John Au; George R. Bailie, PharmD, PhD; George L. Bakris, MD; Vinod K. Bansal, MD; William Barrie, MD; Ruth Barry, RN; Bruce Becker, MD; Stengel Benedide, MD, PhD; Jeffrey S. Berns, MD; Richard K. Bernstein, MD, FACE, FACN, CWS; Charles W. Bishop, PhD; Roland C. Blantz, MD; Wendy T. Blouin, RN, BSN, CNN; Kline Bolton, MD, FACP; Jürgen Bommer, MD; Peggy Borum, PhD; James Brandes, MD; Delia Bravo, BSN, RN; Emmanuel Bravo, MD; Deborah I. Brommage, MS, RD, CSR; Eileen Brophy; Joanne Brown, BSN, RN, CNN, CPHQ; Wendy W. Brown, MD; Juan P. Bosch, MD; Sally Burrows-Hudson, MS, RN; Jerrilynn D. Burrowes, MS, RD, CDN; Carrie Butler; Bernard Canaud, MD; Claudia Campieri, MD; Anthony W. Cappa relli, MD; Fernando Carrera, MD; Judy Castagnola, RN, MSN; Gloria Chaigret, RN, CNN; Alice Chan, RD, CSR, LD; James C. M. Chan, MD; Alfred K. Cheung, MD; Michael P. Cinquegroni, MD; Nathaniel Clark, MS, RD, MD; Eric Cohen, MD; Aldo Colombi, MD; Ann D. Compton, MSN, RNC; Michael Conrad, MD; Rev. Ken Crossman; Gerry Curry, RN, BSN, CNN; Jeffrey A. Cutler, MD; Leslie Debaun, RN, MSN; James A. Delmez, MD; Mary Denno, MSN, RN, CNN; Maria DeVita, MD; Claudia Douglas, MA, CNN, APNC; Earl Dunnigan, MD, FACP; Catherine Dupre, MD; Kathy Edwards, RN; Sharon Ehlers, MA, RN, CNN, CCTC; Sameiro Faaria, MD; Mark D. Faber, MD; Steven Fishbane, MD; Michael J. Flanigan, MD; Edward Foote, PharmD; Harold A. Franch, MD; Blanca Ramos Frendo, MD; Eugene Freund, MD, MSPH; Tony Fuccello, MD, PhD; Wendy Funk Schrag, LMSW, ACSW; Suzanne Gagne, RN, CNN; Scott Garland; Richard S. Goldman, MD; Diane Goodwin, DCI; Frank A. Gotch, MD; John Graham, IV; Jane H. Greene, RD, CSR, LDN; Tomas L. Griebling, MD; Cheryl Grimes, PGDE, DPSN, RGN, ENB; Neil J. Groombridge, RN; Robert A. Gutman, MD; William E. Haley, MD; Morris Hamilton, MD; Tamara Harris, MD, MS; Georg Hasche, MD; Carol M. Headley, RN, MSN; Lee A. Hebert, MD; Mary Jane Helenek, RPN, MS, MBA; Richard N. Hellman; Mary Henderson, RN; Sue High, RN, CNN; Karen Hill, RN, BSN; Lelia Holthus, RN, BS; Walter H. Hörl, MD; Thomas H. Hostetter, MD; Susanna S. Itty, RN, CNN; Bunea Jivanescu; Rosie Jones, RN; Kamyar Kalantar-Zadeh, MD, MPH; Mandip S. Kang, MD; Lynette Kartechner, RN; Bertram L. Kasiske, MD; Douglas Keith, MD; Carol A. Keller, MPA; Gwen A. Kendall, RD,LD; Rita-An Kiely, ACSW, CICSW; Michael J. Klag, MD, MPH; Janice Knouff, RN; Raymond Krediet, MD; Eduardo Lacson, Jr, MD; Craig B. Langman, MD; Sandra Lathrop, RD, CDN; Janez Lavre, MD; Claude Lenfant, MD; Jen Jar Lin, MD, PhD; Stan M. Lindenfield, MD; Francesco Locatelli, MD; Kathy Lueker, RN, CNN; Iain Macdougall, MD; Denise Mafra; Lionel U. Mailloux, MD, FACP; Donna Mapes, DNSc, MS; Gary R. Matzke; Hanna W. Mawad, MD, FACP; Linda M. McCann, RD, LD, CSR; Sally McCulloch, MSN, RN, CNN; Peter A. McCullough, MD, MPH; Patrick McGary, MD; Patrick Mc Kenna, MD; Maureen McKinley, MSW, LCSW, CNSW; Kim Meehl, CNN; C. Kenneth Mehr ling; Ira Meisels, MD; D. Mendelssohn, MD, FRCPC; Judy Mennig, RN, CNN; Maureen A. Michael, RN; Edgar R. Miller, III, MD, PhD; William E. Mitch, MD; Steve Montoya, Jr, MD; Gabriel Morduchowicz, MD; Bruce Z. Morgenstern, MD; Donna Mullen, RN, MSN, ARNP; Joseph V. Nally, Jr, MD; Jean M. Nardini, RN, MSN; Andrew S. Narva, MD; Pauline Nelson, RD; Ellen Newman, RN, CNN; Sheila Nulf; Paul M. Palevsky, MD; Thakor G. Patel, MD; Glenda M. Payne, RN; Tammy B. Pennington, MS, LDN, RD; Robert A. Phillips, MD, PhD, FACC; Delores J. Phipps, RN, CNN; Jean Pirozzi, BS, RN, CNN; Linda Plush, MSN, CNN, CNS/FNP; Geraldine Podgorski, BSN, RN, CNN; K.S. Prabhakar, MD; Debra Punch, RN, BS; Gopal K. Rangan, MD; Susan M. Reams, RD, CSR, LD; Carl Redding, MSW; Doris Redding; Sally I. Rice, LCSW, DCSW; Edward J. Roccella, MD; Noreen K. Rogers; Michele Root, CNS; Jerome Rossert, MD, PhD; Harry Rubenstein, MD; Mark P. Rutkowski, MD; Dori Schatell, MS; Seth Schulman, MD; Mary Ann Sevick, RN, PhD; Gaurang Shah, MD; Robert Shay, MD; Donald J. Sherrard, MD; James Shinaberger, MD; Jeffrey I. Silberzweig; Donald Silverberg MD, FRCP; Erik Skullerud; Donna Smolen, RN, BSM; Ann Snyder-Manson, MSW, CSW, BA; Edward Sondik, PhD; Leslie A. Spry, MD; Susan Stark; Theodore I. Steinman, MD; Pam Stephens, RN; D.G. Struggle, MD; Arlene Sukolsky; Timothy J. Swenson, AND, RN, CNN; Judy H. Taylor, MPH, BSN, RN, CNN; Brendan P. Teehan, MD; Carol A. Tindira, RN, MS, CNN; Vicente E. Torres, MD; Walter Tozzi, MSRPN, MBA; Ambrose Y. Tsang, MD; Shoji Tsujimoto, MD, DMCA; Jonah Ukiwe, MD; Abi Umra; Yoshie Uyeda, RD; Fernando Valderrábano, MD; L.J. Vleming, MD, PhD; Susan Vogel, MHA, RN, CNN; Mary Ann Webb; Burkhard Weimer, MD; Debra Wellman, RN; Nanette Wenger, MD; David C. Wheeler, MD, MRCP; Joseph D. White; Björn Wikström, MD; D. Winearls; Marion Winkler, MS, RD, LDN, CNSD; Nancy M. Wise, RD, MS; Sun Yang, MD; Mujdat Yenicesu, MD; Jeff Zavitz; Carmine Zoccali, MD; and Anthony W. Zydlewski, MD.

Organizations that took part in the review process include: AASK; American Association of Kidney Patients; American College of Physicians–American Society of Internal Medicine; American Diabetes Association; American Nephrology Nurses Association; American Regent Laboratories, Inc; American Society for Parenteral and Enteral Nutrition; American Society of Nephrology; Amgen Inc; Association for the Advancement of Medical Instrumentation; AstraZeneca; Bone Care International; CNNT Executive Committee (NKF); CNSW Executive Committee (NKF); DaVita Dialysis Center; ESRD Network #3; ESRD Network #4; ESRD Network #6; ESRD Network of Florida, Inc, #7; ESRD Network #9/10; ESRD Network #11; Gambro Healthcare; Indian Health Service; Kaiser Permanente; Minority Outreach Committee (NKF); National Center for Health Statistics; National Heart, Lung, Blood Institute; National Institute for Health and Medical Research; National Institute of Diabetes and Digestive and Kidney Disorders; National Kidney Foundation Singapore; Ortho Biotech, Inc; Renal Care Group; Renal Physicians Association; Roche Diagnostics Corporation; Satellite Dialysis Centers, Inc; Scribner Kidney Center; Sigma-Tau Pharamaceuticals; Total Renal Care, Inc.

Participation in the review does not necessarily constitute endorsement of the content of the report by the individuals or the organization or institution they represent.

The National Kidney Foundation, as well as the Work Group, recognize the support of Amgen. The National Kidney Foundation is proud to partner with Amgen on this important initiative.

As Chair of the Work Group, I personally wish to thank the other members of the Work Group who volunteered their time, effort, wisdom, and humor to this project. Their willingness to think about the “big picture” while steadfastly adhering to accuracy about “small details” is responsible for the breadth and depth of these guidelines. I have learned a great deal from them. I would like to give special thanks to the following individuals: Josef Coresh, MD, PhD, Vice-Chair of the Work Group, for his expert analysis of the NHANES III database and wise counsel about the definition and classification of chronic kidney disease; Ronald J. Hogg, MD, Chair of the Pediatric Work Group, who insisted that we enlarge our viewpoint to include the problems of children; Adeera Levin, MD, who volunteered analysis of individual patient data from her study and coordinated presentations by the Work Group representatives; Ethan Balk, MD, MPH, who tirelessly worked with each member of the Work Group to develop forms, review articles, and synthesize data into tables; Ronald D. Perrone, MD, my close colleague of many years, who provided advice on the scope of the evidence review and supervised the nephrology fellows on the Evidence Review Team; and Joseph Lau, MD, whose creativity, practical approach, and humor helped us to overcome all obstacles. Finally, I would like to thank Garabed Eknoyan, MD, whose vision, leadership, and commitment guided me throughout the process.