Chronic Kidney Disease Prognosis in KDIGO Guidelines
This document discusses the categorization of Chronic Kidney Disease (CKD) severity based on eGFR and albumin creatinine ratio according to the KDIGO guidelines. It emphasizes the importance of considering albuminuria in assessing CKD prognosis, alongside eGFR. The KDIGO 2012 persistent albuminuria categories are explained in detail, providing a framework for healthcare professionals to appropriately refer and manage CKD patients.
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Chapter 8: Kidney and Urological disorders NATIONAL DEPARTMENT OF HEALTH AFFORDABLE MEDICINES ESSENTIAL MEDICINES PROGRAMME PRIMARY HEALTHCARE GUIDELINES 2018 1
EVIDENCE Please access the National Essential Medicines List Committee (NEMLC) report for detailed evidence (including rationale, references and costings) informing decision-making on medicine addition, amendments and deletions: http://www.health.gov.za/index.php/standard-treatment-guidelines-and- essential-medicines-list/category/285-phc DISCLAIMER This slide set is an implementation tool and should be used alongside the most recently published STG available on the EML Clinical Guide Application. This information does not supersede or replace the STG itself. 2
Chronic Kidney Disease The KDIGO chronic kidney disease prognosis table has been added. This categorises the severity of Chronic Kidney Disease (CKD) based on both eGFR and albumin creatinine ratio. Rationale: albuminuria in assessment of CKD prognosis, in addition to eGFR. This ensures that CKD patients with albuminuria are appropriately referred. Highlights the importance of considering 3 KDIGO: Kidney Disease: Improving Global Outcomes Guidelines, 2014, as amended
Chronic Kidney Disease Prognosis of CKD by GFR and albuminuria categories: KDIGO 2012 Persistent albuminuria categories Description and range A1 A2 A3 Normal to mildly increased Moderately increased Severely increased ACR* <30 mg/g <3mg/mmol ACR* 30 300 mg/g 3 30 mg/mmol ACR* >300 mg/g >30 mg/mmol Refer Refer Refer Refer G1 G2 Normal or high Mildly decreased 90 2) eGFR categories (ml/min per 1.73m 60 89 description and range Mildly to moderately decreased Refer Refer G3a 45 59 Moderately to severely decreased Severely decreased Refer Refer Refer G3b 30 44 G4 15 29 Refer Refer Refer G5 Kidney failure <15 Refer Refer Refer *ACR: albumin to creatinine ratio in urine specimen. Green: low risk (if no other markers of kidney disease, no CKD); yellow: moderately increased risk; orange: high risk; red: very high risk; A1, A2, A3 = categories of albuminuria; G1, G2, G3a, G3b, G4, G5 = categories of eGFR Adapted from: Levin A, Stevens PE. Summary of KDIGO 2012 CKD Guideline: behind the scenes, need for guidance, and a framework for moving forward. Kidney Int. 2014 Jan;85(1):49-61. https://www.ncbi.nlm.nih.gov/pubmed/24284513 4
