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Cited by 1,811Chronic Kidney Disease and DiabetesAcute Kidney Injury ResearchDialysis and Renal Disease Management

Chronic Kidney Disease Diagnosis and Management: A Review

Chen, Teresa K., Knicely, Daphne H., Grams, Morgan E.·2019·JAMA
DOI 10.1001/jama.2019.14745PMC PMC7015670
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Abstract

Importance: Chronic kidney disease (CKD) is the 16th leading cause of years of life lost worldwide. Appropriate screening, diagnosis, and management by primary care clinicians are necessary to prevent adverse CKD-associated outcomes, including cardiovascular disease, end-stage kidney disease, and death. Observations: Defined as a persistent abnormality in kidney structure or function (eg, glomerular filtration rate [GFR] <60 mL/min/1.73 m2 or albuminuria ≥30 mg per 24 hours) for more than 3 months, CKD affects 8% to 16% of the population worldwide. In developed countries, CKD is most commonly attributed to diabetes and hypertension. However, less than 5% of patients with early CKD report awareness of their disease. Among individuals diagnosed as having CKD, staging and new risk assessment tools that incorporate GFR and albuminuria can help guide treatment, monitoring, and referral strategies. Optimal management of CKD includes cardiovascular risk reduction (eg, statins and blood pressure management), treatment of albuminuria (eg, angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers), avoidance of potential nephrotoxins (eg, nonsteroidal anti-inflammatory drugs), and adjustments to drug dosing (eg, many antibiotics and oral hypoglycemic agents). Patients also require monitoring for complications of CKD, such as hyperkalemia, metabolic acidosis, hyperphosphatemia, vitamin D deficiency, secondary hyperparathyroidism, and anemia. Those at high risk of CKD progression (eg, estimated GFR <30 mL/min/1.73 m2, albuminuria ≥300 mg per 24 hours, or rapid decline in estimated GFR) should be promptly referred to a nephrologist. Conclusions and Relevance: Diagnosis, staging, and appropriate referral of CKD by primary care clinicians are important in reducing the burden of CKD worldwide.

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  • Another CKD-EPI equation that additionally incorporates serum cystatin C increases precision and reduces racial and ethnic bias.

    “Another CKD-EPI equation that additionally incorporates serum cystatin C increases precision and reduces racial and ethnic bias, offering additional value in screening and for confirmation of low eGFR in appropriate cases (23–25).”

    From Diabetes management in chronic kidney disease: a consensus report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) (2022) · cites this paper as [23]

    In “CKD Definition and Staging” (page unavailable), the paper identifies the CKD-EPI creatinine–cystatin C equation and says cystatin C can be added when greater accuracy and precision are needed. It does not say that the equation reduces racial or ethnic bias. Its “Screening for CKD” section discusses creatinine and urine ACR, but does not establish the claimed screening or low-eGFR confirmation benefit for this equation. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

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Cited by

Sorted by citations

Authors
Chen, T. K., Knicely, D. H., & Grams, M. E.
Affiliations
Johns Hopkins University (US)
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2019-10-01
Volume
322
Issue
13
Pages
1294
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.2019.14745
PMC
PMC7015670
OpenAlex
W2977682063
Cited by
1,811
References
11
Citations by year
2026: 244 · 2025: 377 · 2024: 390 · 2023: 329 · 2022: 245 · 2021: 156 · 2020: 66 · 2019: 2 · 2018: 2
FWCI
18.34
Type
journal article
Language
en
Open access
closed
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institute of Diabetes and Digestive and Kidney Diseases (K08DK117068, P30DK079310, R01DK100446, R01DK115534, R01DK108803)
Topics
  • Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
  • Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
  • Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
Keywords
chronic kidney disease, CKD diagnosis, CKD staging, glomerular filtration rate, albuminuria, cardiovascular risk reduction, renin-angiotensin system inhibitors, nephrotoxins, dose adjustment, CKD complications, hyperkalemia, secondary hyperparathyroidism, anemia, nephrology referral, primary care, chronic kidney disease progression
MeSH terms
Glomerular Filtration Rate, Humans, Hypertension, Prognosis, Referral and Consultation, Disease Progression, Risk Assessment, Diabetes Complications, Renal Insufficiency, Chronic

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