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QJM Advance Access originally published online on May 8, 2006
QJM 2006 99(6):365-375; doi:10.1093/qjmed/hcl052
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© The Author 2006. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

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Chronic kidney disease: evolving strategies for detection and management of impaired renal function

M.S. MacGregor1, D.E. Boag2 and A. Innes1

From the 1John Stevenson Lynch Renal Unit, 2Department of Biochemistry, Crosshouse Hospital, NHS Ayrshire & Arran, Kilmarnock, UK

Address correspondence to Dr Mark S. MacGregor, The John Stevenson Lynch Renal Unit, Crosshouse Hospital, NHS Ayrshire & Arran, Kilmarnock KA2 0BE. email: mark.macgregor{at}aaaht.scot.nhs.uk

Nephrologists have long been concerned about late referral of patients with severe kidney disease, and resultant poor outcomes on dialysis. But there is an increasing realisation that mild to moderate chronic kidney disease is far more common than previously appreciated. Furthermore, the main consequence of chronic kidney disease is not progression to dialysis, but increased risk of cardiovascular disease. Chronic kidney disease is at least as common and important a risk factor for cardiovascular disease as diabetes mellitus. The MDRD formula is a well-validated formula to estimate glomerular filtration rate, which is now being widely implemented by clinical chemistry laboratories, and should increase the recognition of chronic kidney disease. The K/DOQI classification of chronic kidney disease has gained international acceptance and provides the structure to guide referral and management. This classification, and associated guidelines, also focus attention on areas where evidence is lacking, and which urgently require research. These current developments will substantially change and improve how chronic kidney disease is identified and managed.


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