1. Improving the prognosis of patients with severely decreased glomerular filtration rate (CKD G4+): conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference
- Author
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Bertrand L. Kasiske, Manjula Kurella Tamura, Kathryn Griffith, Marie Evans, Mustafa Arici, Min Jun, David C. Wheeler, Brenda R. Hemmelgarn, Edgar V. Lerma, Hiddo J.L. Heerspink, Michael Cheung, Kamyar Kalantar-Zadeh, Matthew T. James, Wolfgang C. Winkelmayer, Elke Schäffner, Adeera Levin, Shuchi Anand, Bénédicte Stengel, Kitty J. Jager, Zofia Das-Gupta, Paul E. Stevens, Ali K. Abu-Alfa, Jamie P. Dwyer, Angela Yee-Moon Wang, Amy W. Williams, Nisha Bansal, Dorry L. Segev, Edmund J. Lamb, David M. Charytan, Carol A. Pollock, Danielle M. Nash, Danilo Fliser, Roberto Pecoits-Filho, Miguel A. Vazquez, Kai-Uwe Eckardt, Juan Carlos Julián Mauro, Kate Huffman, Mintu P. Turakhia, Rafael Burgos-Calderon, Andrew S. Levey, Lesley A. Inker, Csaba P. Kovesdy, Marc Froissart, David Harris, Charles A. Herzog, Geoffrey A. Block, Shoshana H. Ballew, Bruce M. Robinson, Donal O'Donoghue, Sankar D. Navaneethan, Josef Coresh, Vera Krane, Francesca Tentori, Navdeep Tangri, Yusuke Tsukamoto, Peter Stenvinkel, John S. Gill, Gregorio T. Obrador, Morgan E. Grams, Marcello Tonelli, Conference Participants, Abu-Alfa, A.K., Anand, S., Arici, M., Ballew, S.H., Block, G.A., Burgos-Calderon, R., Charytan, D.M., Das-Gupta, Z., Dwyer, J.P., Fliser, D., Froissart, M., Gill, J.S., Griffith, K.E., Harris, D.C., Huffman, K., Inker, L.A., Jager, K.J., Jun, M., Kalantar-Zadeh, K., Kasiske, B.L., Kovesdy, C.P., Krane, V., Lamb, E.J., Lerma, E.V., Levey, A.S., Levin, A., Julián Mauro, J.C., Nash, D.M., Navaneethan, S.D., O'Donoghue, D., Obrador, G.T., Pecoits-Filho, R., Robinson, B.M., Schäffner, E., Segev, D.L., Stengel, B., Stenvinkel, P., Tangri, N., Tentori, F., Tsukamoto, Y., Turakhia, M.P., Vazquez, M.A., Yee-Moon Wang, A., Williams, A.W., Groningen Kidney Center (GKC), Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), APH - Aging & Later Life, APH - Quality of Care, APH - Global Health, and ACS - Pulmonary hypertension & thrombosis
- Subjects
medicine.medical_specialty ,Consensus ,Clinical Decision-Making ,030232 urology & nephrology ,Context (language use) ,HEMODIALYSIS-PATIENTS ,Disease ,030204 cardiovascular system & hematology ,urologic and male genital diseases ,Kidney ,Severity of Illness Index ,OUTPUT CARDIAC-FAILURE ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,medicine ,Humans ,Renal Insufficiency, Chronic ,Intensive care medicine ,CARDIOVASCULAR EVENTS ,Evidence-Based Medicine ,business.industry ,INCIDENT HEART-FAILURE ,STAGE RENAL-DISEASE ,INSUFFICIENCY COHORT ,RANDOMIZED CONTROLLED-TRIAL ,medicine.disease ,Prognosis ,female genital diseases and pregnancy complications ,Clinical trial ,chronic kidney disease ,kidney failure ,prediction ,prognosis ,progression ,supportive care ,medicine.anatomical_structure ,Decreased glomerular filtration rate ,Nephrology ,Heart failure ,business ,REDUCED EJECTION FRACTION ,CLINICAL-TRIALS ,Kidney disease ,Cohort study ,DIALYSIS INITIATION ,Glomerular Filtration Rate - Abstract
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.
- Published
- 2017