TY - JOUR
T1 - Improving the prognosis of patients with severely decreased glomerular filtration rate (CKD G4+)
T2 - conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference
AU - Conference Participants
AU - Eckardt, Kai Uwe
AU - Bansal, Nisha
AU - Coresh, Josef
AU - Evans, Marie
AU - Grams, Morgan E.
AU - Herzog, Charles A.
AU - James, Matthew T.
AU - Heerspink, Hiddo J.L.
AU - Pollock, Carol A.
AU - Stevens, Paul E.
AU - Tamura, Manjula Kurella
AU - Tonelli, Marcello A.
AU - Wheeler, David C.
AU - Winkelmayer, Wolfgang C.
AU - Cheung, Michael
AU - Hemmelgarn, Brenda R.
AU - Abu-Alfa, Ali K.
AU - Anand, Shuchi
AU - Arici, Mustafa
AU - Ballew, Shoshana H.
AU - Block, Geoffrey A.
AU - Burgos-Calderon, Rafael
AU - Charytan, David M.
AU - Das-Gupta, Zofia
AU - Dwyer, Jamie P.
AU - Fliser, Danilo
AU - Froissart, Marc
AU - Gill, John S.
AU - Griffith, Kathryn E.
AU - Harris, David C.
AU - Huffman, Kate
AU - Inker, Lesley A.
AU - Jager, Kitty J.
AU - Jun, Min
AU - Kalantar-Zadeh, Kamyar
AU - Kasiske, Bertrand L.
AU - Kovesdy, Csaba P.
AU - Krane, Vera
AU - Lamb, Edmund J.
AU - Lerma, Edgar V.
AU - Levey, Andrew S.
AU - Levin, Adeera
AU - Julián Mauro, Juan Carlos
AU - Nash, Danielle M.
AU - Navaneethan, Sankar D.
AU - O'Donoghue, Donal
AU - Obrador, Gregorio T.
AU - Pecoits-Filho, Roberto
AU - Robinson, Bruce M.
AU - Segev, Dorry L.
N1 - Publisher Copyright:
© 2018 International Society of Nephrology
PY - 2018/6
Y1 - 2018/6
N2 - Patients with severely decreased glomerular filtration rate (GFR) (i.e., chronic kidney disease [CKD] G4+) are at increased risk for kidney failure, cardiovascular disease (CVD) events (including heart failure), and death. However, little is known about the variability of outcomes and optimal therapeutic strategies, including initiation of kidney replacement therapy (KRT). Kidney Disease: Improving Global Outcomes (KDIGO) organized a Controversies Conference with an international expert group in December 2016 to address this gap in knowledge. In collaboration with the CKD Prognosis Consortium (CKD-PC) a global meta-analysis of cohort studies (n = 264,515 individuals with CKD G4+) was conducted to better understand the timing of clinical outcomes in patients with CKD G4+ and risk factors for different outcomes. The results confirmed the prognostic value of traditional CVD risk factors in individuals with severely decreased GFR, although the risk estimates vary for kidney and CVD outcomes. A 2- and 4-year model of the probability and timing of kidney failure requiring KRT was also developed. The implications of these findings for patient management were discussed in the context of published evidence under 4 key themes: management of CKD G4+, diagnostic and therapeutic challenges of heart failure, shared decision-making, and optimization of clinical trials in CKD G4+ patients. Participants concluded that variable prognosis of patients with advanced CKD mandates individualized, risk-based management, factoring in competing risks and patient preferences.
AB - Patients with severely decreased glomerular filtration rate (GFR) (i.e., chronic kidney disease [CKD] G4+) are at increased risk for kidney failure, cardiovascular disease (CVD) events (including heart failure), and death. However, little is known about the variability of outcomes and optimal therapeutic strategies, including initiation of kidney replacement therapy (KRT). Kidney Disease: Improving Global Outcomes (KDIGO) organized a Controversies Conference with an international expert group in December 2016 to address this gap in knowledge. In collaboration with the CKD Prognosis Consortium (CKD-PC) a global meta-analysis of cohort studies (n = 264,515 individuals with CKD G4+) was conducted to better understand the timing of clinical outcomes in patients with CKD G4+ and risk factors for different outcomes. The results confirmed the prognostic value of traditional CVD risk factors in individuals with severely decreased GFR, although the risk estimates vary for kidney and CVD outcomes. A 2- and 4-year model of the probability and timing of kidney failure requiring KRT was also developed. The implications of these findings for patient management were discussed in the context of published evidence under 4 key themes: management of CKD G4+, diagnostic and therapeutic challenges of heart failure, shared decision-making, and optimization of clinical trials in CKD G4+ patients. Participants concluded that variable prognosis of patients with advanced CKD mandates individualized, risk-based management, factoring in competing risks and patient preferences.
KW - chronic kidney disease
KW - kidney failure
KW - prediction
KW - prognosis
KW - progression
KW - supportive care
UR - http://www.scopus.com/inward/record.url?scp=85045296577&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85045296577&partnerID=8YFLogxK
U2 - 10.1016/j.kint.2018.02.006
DO - 10.1016/j.kint.2018.02.006
M3 - Article
C2 - 29656903
AN - SCOPUS:85045296577
SN - 0085-2538
VL - 93
SP - 1281
EP - 1292
JO - Kidney international
JF - Kidney international
IS - 6
ER -