Systematic approach for the management of chronic kidney disease: moving beyond chronic kidney disease classification.
OBJECTIVE
This review has two aims: to summarize the evolution of classification criteria for chronic kidney disease (CKD) for diagnosis, prognosis and forecasting population burden of illness; to move the discussion beyond classification to intervention by introducing an approach we describe as the 'Systematic Approach for the Management of CKD' (SAM-CKD).


RESULTS
There is now ample evidence against the use of estimated GFR (eGFR) as the sole criterion for classifying CKD for the purpose of diagnosis, risk stratification and prediction of progression. There is ample evidence that significant proteinuria is a powerful predictor of progression but even more so when combined with reduced eGFR for individual and population risk projection. Hypertension also is an important indicator in CKD progression but not in all studies. Beyond classification, there are no studies addressing standardization of management of CKD to achieve the outcomes articulated by any of the practice guidelines.


CONCLUSIONS
In this article we have moved the discussions of CKD beyond classification by introducing a clinical management tool, SAM-CKD, which couples a broader classification model with a systematic tool for management to foster standardization of CKD management for the future.
Burgos-Calderon
Rafael
R
Department of Medicine, University of Puerto Rico, School of Medicine, San Juan, Puerto Rico 00936-5067. rburgosc@prtc.net
Depine
Santos
S
D002318:Cardiovascular Diseases / Q000209:etiology / Q000473:pathology; D018450:Disease Progression; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000145:classification* / Q000150:complications / Q000628:therapy*; D007843:Latin America; D010347:Patient Care Planning; D011320:Primary Health Care