Improving the prognosis of patients with severely decreased glomerular filtration rate (CKD G4+)

conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Conference Participants

Research output: Contribution to journalArticle

8 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1281-1292
Number of pages12
JournalKidney International
Volume93
Issue number6
DOIs
StatePublished - Jun 1 2018

Fingerprint

Kidney Diseases
Glomerular Filtration Rate
Chronic Renal Insufficiency
Cardiovascular Diseases
Renal Replacement Therapy
Renal Insufficiency
Heart Failure
Patient Preference
Risk Management
Meta-Analysis
Decision Making
Cohort Studies
Clinical Trials
Therapeutics

All Science Journal Classification (ASJC) codes

  • Nephrology

Cite this

@article{313a63d2d1c84e8b8930e46a9f48bfb4,
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",
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.",
author = "{Conference Participants} and Eckardt, {Kai Uwe} and Nisha Bansal and Josef Coresh and Marie Evans and Grams, {Morgan E.} and Herzog, {Charles A.} and James, {Matthew T.} and Heerspink, {Hiddo J.L.} and Pollock, {Carol A.} and Stevens, {Paul E.} and Tamura, {Manjula Kurella} and Tonelli, {Marcello A.} and Wheeler, {David C.} and Winkelmayer, {Wolfgang C.} and Michael Cheung and Hemmelgarn, {Brenda R.} and Abu-Alfa, {Ali K.} and Shuchi Anand and Mustafa Arici and Ballew, {Shoshana H.} and Block, {Geoffrey A.} and Rafael Burgos-Calderon and Charytan, {David M.} and Zofia Das-Gupta and Dwyer, {Jamie P.} and Danilo Fliser and Marc Froissart and Gill, {John S.} and Griffith, {Kathryn E.} and Harris, {David C.} and Kate Huffman and Inker, {Lesley A.} and Jager, {Kitty J.} and Min Jun and Kamyar Kalantar-Zadeh and Kasiske, {Bertrand L.} and Kovesdy, {Csaba P.} and Vera Krane and Lamb, {Edmund J.} and Lerma, {Edgar V.} and Levey, {Andrew S.} and Adeera Levin and {Juli{\'a}n Mauro}, {Juan Carlos} and Nash, {Danielle M.} and Navaneethan, {Sankar D.} and Csaba Kovesdy and Obrador, {Gregorio T.} and Roberto Pecoits-Filho and Robinson, {Bruce M.} and Elke Sch{\"a}ffner",
year = "2018",
month = "6",
day = "1",
doi = "10.1016/j.kint.2018.02.006",
language = "English (US)",
volume = "93",
pages = "1281--1292",
journal = "Kidney International",
issn = "0085-2538",
publisher = "Nature Publishing Group",
number = "6",

}

TY - JOUR

T1 - Improving the prognosis of patients with severely decreased glomerular filtration rate (CKD G4+)

T2 - conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

AU - Conference Participants

AU - Eckardt, Kai Uwe

AU - Bansal, Nisha

AU - Coresh, Josef

AU - Evans, Marie

AU - Grams, Morgan E.

AU - Herzog, Charles A.

AU - James, Matthew T.

AU - Heerspink, Hiddo J.L.

AU - Pollock, Carol A.

AU - Stevens, Paul E.

AU - Tamura, Manjula Kurella

AU - Tonelli, Marcello A.

AU - Wheeler, David C.

AU - Winkelmayer, Wolfgang C.

AU - Cheung, Michael

AU - Hemmelgarn, Brenda R.

AU - Abu-Alfa, Ali K.

AU - Anand, Shuchi

AU - Arici, Mustafa

AU - Ballew, Shoshana H.

AU - Block, Geoffrey A.

AU - Burgos-Calderon, Rafael

AU - Charytan, David M.

AU - Das-Gupta, Zofia

AU - Dwyer, Jamie P.

AU - Fliser, Danilo

AU - Froissart, Marc

AU - Gill, John S.

AU - Griffith, Kathryn E.

AU - Harris, David C.

AU - Huffman, Kate

AU - Inker, Lesley A.

AU - Jager, Kitty J.

AU - Jun, Min

AU - Kalantar-Zadeh, Kamyar

AU - Kasiske, Bertrand L.

AU - Kovesdy, Csaba P.

AU - Krane, Vera

AU - Lamb, Edmund J.

AU - Lerma, Edgar V.

AU - Levey, Andrew S.

AU - Levin, Adeera

AU - Julián Mauro, Juan Carlos

AU - Nash, Danielle M.

AU - Navaneethan, Sankar D.

AU - Kovesdy, Csaba

AU - Obrador, Gregorio T.

AU - Pecoits-Filho, Roberto

AU - Robinson, Bruce M.

AU - Schäffner, Elke

PY - 2018/6/1

Y1 - 2018/6/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85045296577&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85045296577&partnerID=8YFLogxK

U2 - 10.1016/j.kint.2018.02.006

DO - 10.1016/j.kint.2018.02.006

M3 - Article

VL - 93

SP - 1281

EP - 1292

JO - Kidney International

JF - Kidney International

SN - 0085-2538

IS - 6

ER -