The definition, classification, and prognosis of chronic kidney disease: A KDIGO Controversies Conference report

Andrew S. Levey, Paul E. De Jong, Josef Coresh, Meguid El Nahas, Brad C. Astor, Kunihiro Matsushita, Ron T. Gansevoort, Bertram L. Kasiske, Kai Uwe Eckardt

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The definition and classification for chronic kidney disease was proposed by the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) in 2002 and endorsed by the Kidney Disease: Improving Global Outcomes (KDIGO) in 2004. This framework promoted increased attention to chronic kidney disease in clinical practice, research and public health, but has also generated debate. It was the position of KDIGO and KDOQI that the definition and classification should reflect patient prognosis and that an analysis of outcomes would answer key questions underlying the debate. KDIGO initiated a collaborative meta-analysis and sponsored a Controversies Conference in October 2009 to examine the relationship of estimated glomerular filtration rate (GFR) and albuminuria to mortality and kidney outcomes. On the basis of analyses in 45 cohorts that included 1,555,332 participants from general, high-risk, and kidney disease populations, conference attendees agreed to retain the current definition for chronic kidney disease of a GFR 60 ml/min per 1.73 m 2 or a urinary albumin-to-creatinine ratio 30 mg/g, and to modify the classification by adding albuminuria stage, subdivision of stage 3, and emphasizing clinical diagnosis. Prognosis could then be assigned based on the clinical diagnosis, stage, and other key factors relevant to specific outcomes. KDIGO has now convened a workgroup to develop a global clinical practice guideline for the definition, classification, and prognosis of chronic kidney disease.

Original languageEnglish (US)
Pages (from-to)17-28
Number of pages12
JournalKidney international
Issue number1
StatePublished - Jul 2011

Bibliographical note

Funding Information:
We thank the following members for their contributions: Planning committee: Andrew S Levey, MD, USA; Meguid El Nahas, MD, UK; Paul E de Jong, MD, PhD, The Netherlands; Josef Coresh, MD, PhD, USA; Kai-Uwe Eckardt, MD, Germany; Bertram Kasiske, USA. Analytic team: Josef Coresh, MD, PhD, USA; Brad Astor, PhD, USA; Kunihiro Matsushita, MD, PhD, USA; Priscilla Auguste, MHS, USA; Yaping Wang, ScM, USA; Mark Woodward, PhD, Australia. Paul E de Jong, MD, PhD, The Netherlands; Ron T Gansevoort, MD, PhD, The Netherlands; Marije van der Velde, The Netherlands; Kasper Veldhuis, The Netherlands. Other invited speakers: Richard Glassock, MD, MACP, USA; Greg Miller, PhD, USA; Lesley Stevens, MD, MS, USA; Brenda Hemmelgarn, MD, PhD, Canada; William McClellan, MD, MPH, USA; Michael Shlipak, MD, MPH, USA. Other breakout group leaders: Marcello Tonelli, MD, Canada; Dick de Zeeuw, MD, PhD, The Netherlands; Adeera Levin, MD, Canada; Tazeen Jafar, MD, MPH, Pakistan. Others who participated in pilot tests: Ronit Katz, PhD, USA; Shih-Jen Hwang, PhD, USA, Anita Lloyd, MSc, Canada; Brian J Lee, MD, USA. Support: The London Conference was organized by Kidney Disease: Improving Global Outcomes (KDIGO). KDIGO initiatives are supported by a consortium of sponsors, who are listed on the KDIGO website ( accessed May 24, 2010). The Chronic Kidney Disease Prognosis Consortium is supported by KDIGO and the US National Kidney Foundation. The meta-analyses work conducted jointly at the Johns Hopkins School of Public Health, Baltimore, USA and the University Medical Center Groningen, Groningen, The Netherlands, was supported by the US National Kidney Foundation and the Dutch Kidney Foundation, respectively. A variety of institutions supported the cohorts contributing to the Chronic Kidney Disease Prognosis Consortium and are described in publications by these cohorts. Some individuals had multiple roles. Except for members of the Planning Committee and Analytic Group, individuals are listed only once.


  • albuminuria
  • chronic kidney disease
  • classification
  • definition
  • glomerular filtration rate
  • prognosis


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