Classification of Chronic Kidney Disease - Historic Perspective: From Insufficiency and Failure to Chronic Kidney Disease

CKD was introduced in 2002 as a set of clinical practice guidelines (CPG) that defined the term, stratified it into stages on the basis of severity, and described its clinical course and complications. The result has been a paradigm shift which has not only transformed nephrology as a discipline, but also affected the practice of medicine in general. A practical list of the most common risk factors to target for CKD testing includes diabetes, hypertension, family history of kidney failure and age 60 years and older. The eGFR and urinary albumin-creatinine ratio (ACR) guide detection, assess prognosis and determine management. The majority of care for CKD patients will necessarily be delivered by primary care clinicians, since CKD is common, with a prevalence of approximately 10% of the population of industrialized nations. Nephrology referral is recommended for advanced CKD, and is essential for preparation for RRT and the delivery of optimal care during patients' transitions to kidney failure. Preliminary data support an impact of the CKD CPG, increasing clinical research as well as improving patient management. Health services research in the coming years will more clearly characterize the impact of the CKD CPG on patient outcomes.