Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts, USA.
Kidney Int. 2011 Jul;80(1):17-28. doi: 10.1038/ki.2010.483. Epub 2010 Dec 8.
The definition and classification for chronic kidney disease was proposed by the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) in 2002 and endorsed by the Kidney Disease: Improving Global Outcomes (KDIGO) in 2004. This framework promoted increased attention to chronic kidney disease in clinical practice, research and public health, but has also generated debate. It was the position of KDIGO and KDOQI that the definition and classification should reflect patient prognosis and that an analysis of outcomes would answer key questions underlying the debate. KDIGO initiated a collaborative meta-analysis and sponsored a Controversies Conference in October 2009 to examine the relationship of estimated glomerular filtration rate (GFR) and albuminuria to mortality and kidney outcomes. On the basis of analyses in 45 cohorts that included 1,555,332 participants from general, high-risk, and kidney disease populations, conference attendees agreed to retain the current definition for chronic kidney disease of a GFR <60 ml/min per 1.73 m(2) or a urinary albumin-to-creatinine ratio >30 mg/g, and to modify the classification by adding albuminuria stage, subdivision of stage 3, and emphasizing clinical diagnosis. Prognosis could then be assigned based on the clinical diagnosis, stage, and other key factors relevant to specific outcomes. KDIGO has now convened a workgroup to develop a global clinical practice guideline for the definition, classification, and prognosis of chronic kidney disease.
慢性肾脏病的定义和分类由美国国家肾脏病基金会肾脏病预后质量倡议（NKF-KDOQI）于 2002 年提出，并于 2004 年得到改善全球肾脏病预后组织（KDIGO）的认可。这一框架在临床实践、研究和公共卫生领域促进了对慢性肾脏病的更多关注，但也引发了争议。KDIGO 和 KDOQI 的立场是，定义和分类应反映患者的预后，而对结果的分析将回答辩论背后的关键问题。KDIGO 启动了一项协作荟萃分析，并于 2009 年 10 月赞助了一场争议会议，以研究估算肾小球滤过率（GFR）和白蛋白尿与死亡率和肾脏结局的关系。基于包括来自普通人群、高危人群和肾脏病人群的 45 个队列中 1,555,332 名参与者的分析，会议代表们同意保留目前的慢性肾脏病定义，即 GFR<60ml/min/1.73m2或尿白蛋白/肌酐比值>30mg/g，并通过增加白蛋白尿分期、3 期细分和强调临床诊断来修改分类。然后可以根据临床诊断、分期和其他与特定结局相关的关键因素来分配预后。KDIGO 现在已经召集了一个工作组，为慢性肾脏病的定义、分类和预后制定全球临床实践指南。
