Potential advantages and limitations of applying the chronic kidney disease classification to kidney transplant recipients.
The National Kidney Foundation (NKF) Kidney Disease Outcomes Quality Initiative (K/DOQI) classification of Chronic Kidney Disease (CKD) characterizes patients by their level of kidney function and includes kidney transplant recipients (KTRs). Most KTRs have stage > or = 3 CKD (estimated glomerular filtration rate < 60 mL/min/1.73 m2) and may benefit from aggressive CKD care. Recent modifications to the K/DOQI CKD classification reflect the recognition of KTRs as a unique subset of CKD patients in whom the presentation, progression and implications of CKD may vary from those in nontransplant CKD populations. Currently, there is limited information about how adopting the CKD classification in KTRs will influence clinical management and outcomes. Appropriately designed studies are needed to develop transplant-specific CKD treatment recommendations, and to ensure patient, health provider and payer acceptance of the continued need for aggressive CKD care after transplantation. Education and implementation strategies will be required to ensure appropriate integration of the CKD classification and treatment guidelines into existing posttransplant care programs. The CKD classification thus represents an exciting potential strategy to improve clinical outcomes that should be adopted, further studied and modified to incorporate considerations unique to KTRs.
Gill
J S
JS
Division of Nephrology, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada. jgill@providencehealth.bc.ca
D002318:Cardiovascular Diseases / Q000453:epidemiology; D015897:Comorbidity; D006085:Graft Survival; D006801:Humans; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D051436:Renal Insufficiency, Chronic / Q000145:classification* / Q000453:epidemiology / Q000601:surgery*; D015203:Reproducibility of Results; D014184:Transplantation, Homologous