In 2012, KDIGO issued a clinical practice guideline for the management of blood pressure in chronic kidney disease (CKD) which excluded patients receiving maintenance dialysis. This guideline is now being revised on the basis of new clinical trial evidence, particularly from SPRINT, SPS3, and others. A multidisciplinary KDIGO guideline panel of clinical and scientific experts has convened in person and over teleconferences to discuss the excellent work of the Evidence Review Team with the aim to publish an update to the 2012 guideline in 2020. This revision will address several major subjects, such as optimal blood pressure (BP) measurement techniques,
Over the past decade, Kidney Disease: Improving Global Outcomes (KDIGO) has established as a leading global force in making observations about the practice of kidney health care and in synthesizing recommendations for best practices. This has occurred through staging Controversies Conferences with global experts and practitioners on relevant topics in kidney health, developing Clinical Practice Guidelines, and building a portfolio of Implementation Programs through which the products from the aforementioned two activities are interpreted and discussed in the local or regional context. All these activities are based on the premise articulated in KDIGO’s mission statement: to improve the health of
“Rules are for the guidance of wise men and the obedience of fools.” Group Captain Sir Douglas Bader, 1910–1982
One of the first major guidelines in nephrology was the Dialysis Outcomes Quality Initiatives (DOQI), which later morphed into the KDOQI guidelines that we all know today. Good as they were, they were developed by the National Kidney Foundation, based in the United States, and other countries went their own way. The Canadian Society of Nephrology has had slightly different variations in their guidelines, its last major one from 2011, on the timing of initiation of dialysis (1).
It is now seven years since the KDIGO guideline on anemia management in chronic kidney disease (CKD) was published in August 2012 (1). To accuse KDIGO of being lazy and idle in generating any updates or revisions would be inappropriate on two accounts.
First, and most important, there has really not been enough truly robust scientific data that would dramatically alter the evidence base from the previous version of the anemia guideline, in which the four NEJM “biggies” on erythropoiesis stimulating agent (ESA) therapy were reviewed and critiqued by the evidence review team: US Normal Hematocrit
In November 2017, KDIGO hosted a Controversies Conference in Singapore on glomerular diseases. The goal was to determine the best practice and evidence gaps in the treatment of glomerular diseases, review the key literature published since the 2012 KDIGO Glomerulonephritis (GN) Guideline, identify topics or issues for future guideline updating, and outline unmet needs in the management of GN (1, 2).
Since the 2012 KDIGO GN guideline, there have been marked advances in our understanding of the pathogenesis, diagnosis, and potential new treatment approaches or therapeutic agents for several glomerular diseases. A few highlights follow.
Krista L. Lentine, Andrew S. Levey, and Amit X. Garg
Since the advent of the successful practice of living donor kidney transplantation more than 60 years ago, over 150,000 healthy persons in the United States have donated a kidney to help a family member, a friend, or even a stranger. Currently, more than 30,000 living kidney donations are performed worldwide each year. Living donor transplantation is clearly established as the best treatment option for kidney failure, offering patients the best chance of long-term dialysis-free survival, with a better quality of life, at lowest costs to the healthcare system. However, despite the tremendous benefits to recipients and society, the outcomes in
The 2008 KDIGO guideline on the prevention, diagnosis, evaluation, and treatment of hepatitis C virus (HCV) infection in patients with chronic kidney disease (CKD) was the very first guideline produced by KDIGO. Since then, there have been dramatic changes in the field of antiviral treatments, which prompted a timely reassessment and publication of this guideline update in 2018 (1). The purpose of this short review is to summarize the key recommendations from this important guidance document.
As in the previous guideline edition, Chapter 1 addresses the detection and evaluation of HCV in CKD. It should be stressed that
An aging ESRD population with complex medical issues demands our attention. As nephrologists, we must seek to discover the best ways to achieve quality care and quality of life for these individuals and their families within a cost-constrained health care environment.
Older adults with ESRD have the option of withholding dialysis or withdrawing from dialysis when the burden outweighs the potential benefits. In these situations hospice care is one intervention that supports quality care, quality of life, and reduced health care costs through symptom management, spiritual and psychosocial support, and avoidance of unnecessary hospitalizations. Hospice care, however, continues to be
Dale Lupu, Alvin H. Moss, Armistead Nancy, and Brandy Vinson
“There’s no doubt that my wife and I waited too long to have that discussion, and part of that is—my wife is very quiet … we’ve been married for 55 years. So we never really had that discussion. And before I realized, it was kind of too late.” (interview 6, man, health care proxy for patient with cognitive impairment)(1).
“I think that discussion should come before you get to the critical point. At the jump of a dime things could turn, so I think the more prepared you are, the better you could handle things when situations get
The US dialysis population is growing faster than the number of new nephrologists. At the same time, our population is aging, and there is a shortage of geriatricians. Beyond efforts to expand the nephrology and geriatrics workforces, it is also extremely important to pursue interdisciplinary collaboration. How can we ensure that older adults receiving dialysis receive quality care for their geriatric conditions? How can geriatricians be great partners in managing older adults with chronic kidney disease? Communication between nephrologists and geriatricians will add value for patient care and generate ideas for research.