Consensus Statements of the ISN 2004 Consensus Workshop on Prevention of Progression of Renal Disease, Hong Kong, June 29, 2004

The International Society of Nephrology recommends reference to these statements when formulating policy and guidelines for tackling chronic kidney disease, a disease with significant global impact.

1. It is recommended to establish a global surveillance center (ISN Kidney Disease Data Center or ISN KDDC) to coordinate worldwide standardized screening studies with standardized screening techniques in appropriate target groups to allow for the collection of clearly comparable data.
2. It is recommended that patients diagnosed with diabetes and hypertension should have regular screening for development of kidney disease.
3. It is recommended that close relatives of patients with nephropathy due to diabetes, hypertension and glomerulonephritis should also be the primary targets for screening to detect clinically silent kidney disease.
4. No consensus was made on an exact age "cut-off" for initiating chronic kidney disease (CKD) screening.
5. It is recommended to develop standardized region– (or nation–) specific guidelines. It is envisaged that the "tailor-made" tools for a particular region should provide reproducible and comparable results.
6. It is asserted that kidney disease is already a significant public health concern. There should be national policies for both public health and medical professionals to educate their societies on the importance of screening and early detection of kidney disease on prevention.
7. It is recommended to validate the current glomerular filtration rate (GFR) estimation formulas based on ethnicities in different parts of the world.
8. It is recommended to use albumin-creatinine ratios (ACR) to quantify proteinuria and allow for follow-up. However, it is probably cost prohibitive to use ACR as a tool for primary renal disease screening (except in diabetic patients).
9. It is strongly recommended to have the relevant screening for the development of CKD, recognizing its close interrelationship with cardiovascular, diabetic, and chronic metabolic diseases. Traditional cardiovascular disease risk factors should be screened in all patients with CKD. These include documentation of smoking history, measurement of blood pressure, body weight, body mass index, fasting plasma glucose, fasting lipid profile, serum uric acid level, and 12-lead electrocardiogram (ECG).
10. With the validation of GFR formulas in different ethnic groups, it is endorsed that GFR should be estimated from serum creatinine concentration at least yearly in patients with CKD. This should be done more often in patients with GFR below 60 mL/min/1.73 m 2 , GFR decline greater than 4 mL/min/1.73 m 2 , risk factors for faster progression, or exposure to risk factors for acute GFR decline, and in those undergoing treatment to slow progression.
11. It is endorsed that CKD patients should be encouraged to reduce their body weight if over-weight, adopt a healthy eating habit, restrict their dietary salt intake, cease smoking, moderate their alcohol consumption, and increase physical activity.
12. It is endorsed to achieve the target for blood pressure control in CKD patients of below 130/80 mm Hg. It is recommended that adjunctive dietary salt restriction is invariably required. Diuretics and multiple medications in addition to angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARB) may also be used to achieve the blood pressure targets.
13. It is endorsed that glycemic control in diabetic patients with CKD should be optimized to achieve a target fasting plasma glucose of <7.2 mmol/L and a hemoglobin A 1c (HbA 1c ) level of <7%. Hypertensive diabetics and those with micro-albuminuria or macro-albuminuria, whether hypertensive or not, should be treated with either an ACE inhibitor or ARB.
14. It is recognized that further large scale studies to substantiate the combined use of ACE inhibitor and ARB are needed, but that the cost of such combined therapy may be prohibitive for some countries.
15. It is recommended that patients with CKD should be referred to a nephrologist for evaluation when their creatinine clearance is < 30 mL/min/1.73 m 2 , or earlier in patients at risk of rapid progression or in whom doubt exists as to their diagnosis and prognosis.

Formulated on behalf of the Participants of the ISN Consensus Workshop on Prevention of Progression of Renal Disease by Philip Kam-Tao Li, Jan J Weening, John Dirks, Sing Leung Lui, Cheuk Chun Szeto, Sydney Tang, Robert C Atkins, William E Mitch, Kai Ming Chow, Giuseppe D'Amico, Barry I Freedman, David C Harris, Lai-Seong Hooi, Paul E. de Jong, Priscilla Kincaid-Smith, Kar Neng Lai, Evan Lee, Fu-Keung Li, Shan-Yan Lin, Wai-Kei Lo, MK Mani, Timothy Mathew, Mutsumi Murakami, Jia-Qi Qian, Sylvia Ramirez, Thomas Reiser, Yasuhiko Tomino, Matthew K Tong, Wai-Kay Tsang, Kriang Tungsanga, Haiyan Wang, Andrew K Wong, Kim Ming Wong, Wu-Chang Yang, Dick de Zeeuw, Alex W Yu, and Giuseppe Remuzzi.

The following participants held an official capacity at the time of the Workshop:

Robert C Atkins: Immediate Past President, International Society of Nephrology
John Dirks: Chair, COMGAN, International Society of Nephrology
David C Harris: President, Australian & New Zealand Society of Nephrology
Evan J Lee: President, Singapore Society of Nephrology
Philip Kam Tao Li: Chairman, Hong Kong Society of Nephrology
Shan-Yan Lin: Immediate Past President, Chinese Society of Nephrology
Wai-Kei Lo: President Elect, International Society for Peritoneal Dialysis
William E Mitch: President, American Society of Nephrology
Lai-Seong Hooi: President, Malaysian Society of Nephrology
Kriang Tungsanga: President, Thai Society of Nephrology
Jan J Weening: President, International Society of Nephrology
Wu-Chang Yang: President, Taiwan Society of Nephrology

This information was originally published in Kidney International: Li P, Weening J, Dirks J, et al: A report with consensus statements of the International Society of Nephrology 2004 Consensus Workshop on Prevention of Progression of Renal Disease, Hong Kong, June 29, 2004. Kidney Int 67 (s94):s2-27, 2005. © International Society of Nephrology.