Improving the prognosis of patients with severely decreased glomerular filtration rate (CKD G4+): conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference.

Details

Ressource 1Download: Eckardt Improving prognosis in patients CKD G4+ kdigo controversies conference Kidney Int 2018.pdf (1162.34 [Ko])
State: Public
Version: author
Serval ID
serval:BIB_890B6726B88D
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Improving the prognosis of patients with severely decreased glomerular filtration rate (CKD G4+): conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference.
Journal
Kidney international
Author(s)
Eckardt K.U., Bansal N., Coresh J., Evans M., Grams M.E., Herzog C.A., James M.T., Heerspink HJL, Pollock C.A., Stevens P.E., Tamura M.K., Tonelli M.A., Wheeler D.C., Winkelmayer W.C., Cheung M., Hemmelgarn B.R.
Working group(s)
Conference Participants
Contributor(s)
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.
ISSN
1523-1755 (Electronic)
ISSN-L
0085-2538
Publication state
Published
Issued date
06/2018
Peer-reviewed
Oui
Volume
93
Number
6
Pages
1281-1292
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
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.
Keywords
chronic kidney disease, kidney failure, prediction, prognosis, progression, supportive care
Pubmed
Web of science
Open Access
Yes
Create date
17/04/2018 14:42
Last modification date
20/08/2019 15:48
Usage data