Kidney Disease Improving Global Outcomes (KDIGO)
KDIGO is a global non-profit foundation dedicated to improving the care and outcomes of kidney disease patients worldwide. The ISN supports KDIGO guidelines dissemination through its journal, Kidney International, and participates into planning meetings of the KDIGO advisory board. More information on KDIGO can be found by clicking HERE.
KDIGO Position Statement
The ISN Clinical Practice Guidelines Committee (CPGC) examined the Position Statement issued by Kidney Disease: Improvement of Global Outcomes (KDIGO) in March 2005 on the Definition and Classification of Chronic Kidney Disease based on the respective Kidney Disease Outcomes Quality Initiative (K/DOQI) Guidelines published in 2002.
The Committee found this Statement lucid, based on sound evidence, clearly expressed, and applicable across most geographical borders. Members from the developing world consulted leading local nephrologists, who enthusiastically supported this impression.
The Committee agrees with the given definition of CKD (Item I.A) and its five-stage classification (Item I.B), based on structural and functional criteria regardless of the cause (Item I.A.7) and accounting for dialysis and transplantation (Item I.B.2). It concurs with taking proteinuria as a marker of kidney damage (Item 1.A.4), along with other markers as described in Item 1.A.5, particularly hematuria, being an important urinary abnormality with variable clinical significance. The Committee agrees with the recommendation of screening high-risk groups (Item III.D), which should also include geographical and occupational factors (e.g. endemic infections and certain toxins) and taking cost into due consideration.
Since the calculated GFR (eGFR) is the only criterion for classification beyond Stage II, the Committee emphasizes the importance of adequate quality control of serum creatinine measurement (Item II.A), despite concerns on the cost entailed in some developing countries.
Although the cause of CKD is not accounted for in the current classification, the Committee encourages making an etiological diagnosis in individual patients whenever possible, since this may have important therapeutic and prognostic implications. It supports the recommendation to develop a classification by cause (Item I.B.3) and prognosis (I.B.4) whenever available evidence permits.
The Committee supports the research recommendations (Items I.C,II.F,III.E), and emphasizes the importance of including different ethnic groups and indigenous populations in building the evidence, and local physicians in developing consensus for global and regional implementation.