Classifying Risk in Patients With Chronic Kidney Disease

Field: Medicine (Health Sciences)

Letters19 July 2011Classifying Risk in Patients With Chronic Kidney DiseaseMicah L. Thorp, DO, MPHMicah L. Thorp, DO, MPHFrom Kaiser Permanente Northwest, Portland, OR 97267.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-155-2-201107190-00013 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Tonelli and colleagues' excellent study (1) demonstrates that a classification system for chronic kidney disease (CKD) that includes proteinuria in addition to estimated glomerular filtration rate (eGFR) reduces the misclassification of patients compared with the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (KDOQI) classification system. Although the proposed system seems to be more reliable than the KDOQI system, the comparison suffers on 2 counts.First, Tonelli and colleagues used the Modification of Diet in Renal Disease (MDRD) Study (2) equation to estimate glomerular filtration rate (GFR). This equation tends to underestimate GFR among patients with early ...References1. Tonelli M, Muntner P, Lloyd A, Manns BJ, James MT, Klarenbach S, et al; Alberta Kidney Disease Network. Using proteinuria and estimated glomerular filtration rate to classify risk in patients with chronic kidney disease: a cohort study. Ann Intern Med. 2011;154:12-21. [PMID: 21200034] LinkGoogle Scholar2. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999;130:461-70. [PMID: 10075613] LinkGoogle Scholar3. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF, Feldman HI, et al; CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150:604-12. [PMID: 19414839] LinkGoogle Scholar4. NKF KDOQI clinical practice guidelines for chronic kidney disease. Am J Kidney Dis. 2002;39 Suppl 1 76. [PMID: 11904577] MedlineGoogle Scholar5. Thorp ML, Weinstein J, DeVille J, Johnson ES, Petrik A, Yang X, et al. Comparison of renal replacement therapy and mortality using 1 versus 2 estimated glomerular filtration rates. Popul Health Manag. 2009;12:149-55. [PMID: 19534579] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Micah L. Thorp, DO, MPHAffiliations: From Kaiser Permanente Northwest, Portland, OR 97267.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoA More Accurate Method To Estimate Glomerular Filtration Rate from Serum Creatinine: A New Prediction Equation Andrew S. Levey , Juan P. Bosch , Julia Breyer Lewis , Tom Greene , Nancy Rogers , and David Roth , for the Modification of Diet in Renal Disease Study Group*A New Equation to Estimate Glomerular Filtration Rate Andrew S. Levey , Lesley A. Stevens , Christopher H. Schmid , Yaping (Lucy) Zhang , Alejandro F. Castro III , Harold I. Feldman , John W. Kusek , Paul Eggers , Frederick Van Lente , Tom Greene , and Josef Coresh , for the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration)* Using Proteinuria and Estimated Glomerular Filtration Rate to Classify Risk in Patients With Chronic Kidney Disease Marcello Tonelli , Paul Muntner , Anita Lloyd , Braden J. Manns , Matthew T. James , Scott Klarenbach , Robert R. Quinn , Natasha Wiebe , and Brenda R. Hemmelgarn , for the Alberta Kidney Disease NetworkClassifying Risk in Patients With Chronic Kidney Disease Marcello Tonelli , Paul Muntner , and Brenda Hemmelgarn Metrics 19 July 2011Volume 155, Issue 2Page: 134KeywordsChronic kidney diseaseConflicts of interestDietEstimated glomerular filtration rateGlomerular filtration rateProteinuriaRenal diseasesRenal failureSystemic diseases ePublished: 19 July 2011 Issue Published: 19 July 2011 Copyright & PermissionsCopyright © 2011 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...