KDIGO: A Promise Unfilled

KDIGO: A Promise Unfilled

The KDIGO Clinical Practice Guideline for the Care of Kidney Transplant Recipients was the third Kidney Disease: Improving Global Outcomes (KDIGO) guideline, published in November 2009 as a supplement to the American Journal of Transplantation. This guideline addressed a broader set of issues than did the previous two guidelines (for hepatitis C and bone and mineral disease). The guideline was written for clinicians (doctors, nurses, coordinators, and pharmacists) providing care to patients who have received a transplant.

The World Health Organization defines anemia in adults and children older than 15 years as a hemoglobin concentration (Hb) <13.0 g/dL in male individuals and <12.0 g/dL in female individuals. In children aged 1.5 to 5 years anemia is defined as Hb <11 g/dL, in those 5 to 12 years as <11.5 g/dL, and in those 12 to 15 years as <12 g/dL (1).

The authors of the Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guideline for acute kidney injury (1) are often asked two important questions: “Who is the guideline for?” and “Is acute kidney injury (AKI) preventable?”

During the 1980s and 1990s, the focus of dealing with disorders of bone and mineral metabolism was predominantly “bone centric,” with parathyroid hormone (PTH) the main culprit and calcium the primary regulator of PTH. The term “renal osteodystrophy” was generally used to encompass these disorders. The focus of therapy was to maintain relatively high serum calcium concentrations in order to suppress PTH, which would presumably result in normal bone.

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In 1995, the National Kidney Foundation spearheaded the development of the first broadly accepted clinical practice guidelines in nephrology, the Kidney Disease Outcomes Quality Initiative (KDOQI).

First published in 1997, these “guidelines” made a significant impact in the quality of care for kidney patients in the United States and across the world.

Glomerulonephritis (GN)—including both primary and secondary variants in aggregate—remains one of the most common types of kidney disease that progresses to end stage renal disease (ESRD). However, this fact alone seriously underestimates the extent of the problem associated with GN. Many cases of the disease begin early in life and can have a devastating effect both on the individual and their families.

Hepatitis C virus (HCV) affects approximately 4 million Americans, and can trigger, share risk factors for, or result from CKD. Besides causing glomerulonephritis, HCV is associated with diabetes, a CKD precursor. End stage renal disease (ESRD) is a risk factor for HCV, transmitted via transfusions or transplantation in the era preceding its identification. The estimated HCV prevalence among U.S. CKD patients is 10 percent, several-fold higher than the general population, and is presumed to increase with CKD stage, with demographic variation.