Andrew S Levey

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..Cooperation among federal, state, and local governmental and private organizations will be necessary to carry out these recommendations...

..KDIGO has now convened a workgroup to develop a global clinical practice guideline for the definition, classification, and prognosis of chronic kidney disease...

..We provide data on the frequency of diabetes, hypertension, or both, according to albumin-to-creatinine ratio and eGFR, and review the rationale for retaining the current name...

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..In this Seminar we discuss disease burden, recommendations for assessment and management, and future challenges. We emphasise clinical practice guidelines, clinical trials, and areas of uncertainty...

..Chronic kidney disease (CKD) and obesity are important public health concerns. We examined the association between anthropomorphic measures and incident CKD and mortality...

..Waist-to-hip ratio (WHR) is less influenced by muscle and bone mass than body mass index (BMI). We compared WHR and BMI as risk factors for cardiac events (myocardial infarction and fatal coronary disease) in persons with CKD...

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..CRP levels are independently associated with serum albumin level and CVD prevalence. Inflammation may be involved in the pathophysiological state of malnutrition and CVD in the earlier stages of predominantly nondiabetic kidney disease...

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..We sought to determine the utility of the Framingham equations in individuals with chronic kidney disease (CKD)...

..Arm muscle area was used as an indicator of muscle mass...

..Chronic kidney disease is associated with increased risk for cardiovascular disease and mortality. Both traditional and nontraditional cardiovascular disease risk factors may contribute...

..Although darbepoetin alfa can effectively increase hemoglobin levels, its effect on clinical outcomes in these patients has not been adequately tested...

..43; P = 0.07). HbA(1c) is associated with increased mortality in nondiabetic kidney disease. Hyperglycemia may be a potential therapeutic target and HbA(1c) may be important as a risk stratification tool in this high-risk population...

..However, target-based strategies are confounded by each patient's individual hematopoietic response...

..The authors aimed to identify factors associated with SVR in hemodialysis patients through analysis of individual patient data obtained from systematic review of published literature...

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..Prior studies demonstrating an association between tHcy and CVD risk may have inadequately adjusted for the confounding effects of kidney function...

..We examined the effect of a very low-protein diet on the development of kidney failure and death during long-term follow-up of the Modification of Diet in Renal Disease (MDRD) Study...

..We compare the discriminatory accuracy of 1 year mortality predictions derived from four comorbidity instruments in a large representative US dialysis population...

..Knowing whether risk factors for mortality differ in dialysis patients who survive longer and the strengths of these risk factors for mortality change over time would assist physicians in making better prognostic judgments...

..66) for all-cause mortality. Anemia was not a risk factor for any outcome in those without CKD (P > 0.2 for all outcomes). In persons with diabetes, anemia is primarily a risk factor for adverse outcomes in those who also have CKD...

..Hyperuricemia is prevalent in patients with chronic kidney disease (CKD); however, data are limited about the relationship of uric acid levels with long-term outcomes in this patient population...

..The objective of this study was to determine the association of serum β-trace protein with mortality in incident hemodialysis patients...

..0 g/d. Systolic blood pressure less than 110 mm Hg may be associated with a higher risk for kidney disease progression...

..Chronic kidney disease is a risk factor for cardiovascular disease (CVD); however, it is uncertain if CVD is a risk factor for progression or development of kidney disease...

..A linear model best described the relationship between GFR and CVD. CONCLUSION: The level of GFR is an independent risk factor for CVD, de novo CVD, and all-cause mortality in the elderly...

..Longitudinal change in the comorbid illness burden of incident dialysis patients has not been measured. Comorbidity severity and its change may serve as important prognostic markers of survival, independent of other case-mix factors...

..Therefore, we undertook this analysis to explore the independent association of renal disease progression with gender...

..Hence, we found that cystatin C is affected by factors other than GFR which should be considered when the GFR is estimated using serum levels of cystatin C...

..We report the development and evaluation of GFR-estimating equations using serum cystatin C alone and serum cystatin C, serum creatinine, or both with demographic variables...

..CONCLUSION: The presence of CKD in a community-based population with preexisting CVD is associated with an increased risk for recurrent CVD outcomes. This increased risk persists after adjustment for traditional CVD risk factors...

..There is insufficient evidence to suggest that low tHcy is associated with poor nutritional status in the MDRD Study cohort. B vitamins and GFR, but not dietary protein, are the major determinants of tHcy in this patient population...

..Data are limited on the relationship of BMI with mortality in patients in the earlier stages of chronic kidney disease (CKD)...

..Equations to estimate glomerular filtration rate (GFR) are routinely used to assess kidney function. Current equations have limited precision and systematically underestimate measured GFR at higher values...

..High CRP, but not serum albumin, is a risk factor for cardiovascular mortality. These results suggest that high CRP and hypoalbuminemia provide prognostic information independent of each other in CKD...

..We performed a patient-level meta-analysis to compare the effect of antihypertensive regimens, including ACE inhibitors, to those without ACE inhibitors (controls) on kidney disease progression in patients with PKD...

..CONCLUSION: The efficacy of a 2- to 3-year intervention of dietary protein restriction on progression of nondiabetic kidney disease remains inconclusive. Future studies should include a longer duration of intervention and follow-up...

..Hence, cystatin C may allow more accurate estimates of GFR than creatinine for patients with reduced protein intake. Further study of other non-GFR determinants of cystatin C is needed before the widespread adoption...

..Variation in performance of glomerular filtration rate (GFR) estimating equations is related to variation in calibration of the creatinine assay across clinical laboratories...

..Cystatin C is an alternative filtration marker for estimating GFR...

..trace protein and cystatin C seem to provide more consistent prognostic information than creatinine...

..It is unknown whether defining chronic kidney disease (CKD) based on one versus two estimated glomerular filtration rate (eGFR) assessments changes the prognostic importance of reduced eGFR in a community-based population...

..06 to 1.53). CONCLUSION: In this large cohort of initially healthy men, BMI was associated significantly with increased risk for CKD after 14 years. Strategies to decrease CKD risk might include prevention of overweight and obesity...

..Chronic kidney disease (CKD) is a risk factor for cardiovascular disease (CVD)...

..Hypertension is a risk factor for progression of chronic kidney disease. The optimal blood pressure to slow progression is unknown...

..To compare self-report of eight diseases with review of medical records and physician reports...

..Further studies are necessary to confirm this association and to elucidate the underlying mechanisms...

..13) for ASCVD, de novo ASCVD, and recurrent ASCVD, respectively. A nonlinear model did not fit the data better than a linear model. CONCLUSIONS: The level of GFR is an independent risk factor for ASCVD and de novo ASCVD in the ARIC study...

..Concurrently, CVD may promote CKD, resulting in a vicious cycle. We evaluated this hypothesis by exploring whether CKD and CVD have an additive or synergistic effect on future cardiovascular and mortality outcomes...

..CKD and elevated SBP are independent risk factors for incident stroke. In CKD, individuals with the lowest BP are at increased risk for stroke. This pattern is not seen in the general population...

..We sought to determine which conditions are most prognostic and whether comorbidity continues to contribute to a survival model once laboratory and clinical parameters have been accounted for...

..Here, performance of a more accurate GFR-estimating equation, the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, is reported by level of GFR and clinical characteristics...

..We sought to reexpress the 4-variable Modification of Diet in Renal Disease (MDRD) Study equation for estimation of glomerular filtration rate (GFR) using serum creatinine (S(cr)) standardized to reference methods...

..Accordingly, we assessed the prevalence of cognitive impairment and depressive symptoms in transplant recipients and their association with kidney function, plasma total homocysteine, and B-vitamin concentrations...

..Here, we describe the development and validation of this equation as well as other equations that incorporate diabetes, transplant and weight as additional predictor variables...

..We examined the value of troponin T (TnT) and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) in assessing the risk of developing end-stage renal disease (ESRD) in diabetic patients with CKD...

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..The authors describe the prevalence, demographics, and trends in overweight and obesity at the time of kidney transplantation...

..This association may be due to the positive effect of collaborative discussion by the patient care team of short- and long-term care goals for individual patients...

..Patients with proteinuria <500 mg/d do not seem to benefit, even when at relatively high risk for progression...

..15 [95% CI, 2.62 to 6.56] and 3.92 [95% CI, 2.05 to 7.48]; P = 0.02 and 0.01 for interaction term, respectively). The combination of anemia and LVH in CKD identifies a high-risk population...

..It is hypothesized that this effect may be due to more frequent or more severe subclinical vascular disease secondary to hypertension or diabetes in black individuals...

..In vitro and in vivo data suggest that markers of inflammation and nutritional status may be risk factors for the progression of chronic kidney disease...

..The Framingham equations were developed to predict incident coronary heart disease. It remains unknown how the presence of chronic kidney disease affects their performance...

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..Adjustment for case-mix differences in patients treated with PD versus HD is essential to the assessment of the independent effect of the dialysis modality on outcomes...

..We recommend collaboration among many groups, including academia, industry, the FDA, and the National Institutes of Health, to share data from past and future studies...

..Thus, heterogeneity in performance among the ethnic and geographic groups precludes use of the four-level race equation. The CKD-EPI two-level race equation can be used in the United States and Europe across a wide range of ethnicity...

..These threshold levels have not been rigorously evaluated in patients with diabetic kidney disease or by using urine albumin excretion, the preferred measure of proteinuria in patients with diabetes...

..Albuminuria, a kidney marker of microvascular disease, may herald microvascular disease elsewhere, including in the brain...

..Treatment recommendations are provided using evidence available from populations with CKD or evidence extrapolated from the general population when there are insufficient data on individuals with CKD...

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..Kidney disease treatment by dialysis and transplantation should be noted. Simple, uniform classifications of CKD by cause and by risks for kidney disease progression and CVD should be developed...

..We suggest plasma clearance of nonradioactive markers be more widely implemented in clinical settings. Further research is necessary on the impact of the use of measured GFR as a confirmatory test...

..Repeated testing for urine protein and interpretation of GFR estimates in the context of kidney damage and the clinical context of patient presentation can help overcome these limitations...

..Serum creatinine level may underestimate the prevalence of CKD in subjects with decreased lean body mass or liver disease. Level of serum cystatin C, an alternative kidney function marker, is independent of lean body mass...

..In our view, a complete assessment requires a broader perspective. Most patients with CKD do not require referral to a nephrologist. Improving outcomes requires coordinated efforts of all physicians...

..Here, we review the performance of current creatinine and cystatin C-based estimating equations as well as demonstration of their utility in public health and clinical practice...

..There is a reasonably sound biological basis for this hypothesis, but only preliminary empirical evidence currently exists...

..Further study would provide valuable etiological and therapeutic clues...

..73 m(2). In individual patients, interpretation of GFR estimates near 60 ml/min per 1.73 m(2) should be interpreted with caution to avoid misclassification of chronic kidney disease in the context of the clinical setting...

..Because of the high prevalence of early stages of chronic kidney disease in the general population (approximately 11% of adults), this information is particularly important for general internists and specialists...