Winearls Christopher G, Glassock Richard J
Oxford Kidney Unit, The Churchill, Oxford Radcliffe Hospitals NHS Trust, University of Oxford, Headington, Oxford, UK.
Kidney Int. 2009 May;75(10):1009-14. doi: 10.1038/ki.2009.49. Epub 2009 Feb 25.
The current Kidney Disease Outcomes Quality Initiative (KDOQI) staging system of chronic kidney disease (CKD) is simple but too rigid to accommodate variations in renal function observed in the general population. The formula most commonly used to estimate renal function is not validated in subjects without a priori evidence of renal disease. Their combined use results in inappropriate diagnosis of CKD and improbable estimates of prevalence rates. Although this initiative has raised the profile of kidney disease, the exaggeration of the scope of the problem could distract nephrologists from their specialist role. The nephrology community needs a revised staging system for CKD that allows accurate, effective, and timely communication with patients, primary care doctors, public health physicians, and policy makers. Its single most important function will be to identify those patients who will benefit from targeted screening and effective and safe interventions. We offer for discussion a modified definition and staging system of CKD based on the presence of unequivocal, irreversible structural kidney disease, the presence or degree of impairment of kidney function, and the consequences thereof.
当前的慢性肾脏病（CKD）肾脏疾病预后质量倡议（KDOQI）分期系统虽简单，但过于僵化，无法适应普通人群中观察到的肾功能变化。最常用于估算肾功能的公式在无肾脏疾病先验证据的受试者中未经验证。两者结合使用会导致CKD的诊断不当以及患病率估计不合理。尽管该倡议提高了肾脏疾病的关注度，但对问题范围的夸大可能会使肾病学家偏离其专业角色。肾脏病学界需要一个修订后的CKD分期系统，以便与患者、初级保健医生、公共卫生医生和政策制定者进行准确、有效和及时的沟通。其最重要的单一功能将是识别那些将从针对性筛查以及有效和安全干预中受益的患者。我们提出一个基于明确的、不可逆的结构性肾脏疾病的存在、肾功能损害的存在或程度及其后果的CKD改良定义和分期系统供大家讨论。
