The Kidney Disease Improving Global Outcomes (KDIGO) Guideline Update for Chronic Kidney Disease: Evolution not Revolution

In 2002, the US National Kidney Foundation published their seminal Kidney Disease Outcome Quality Initiative (KDOQI)4 guideline on chronic kidney disease (CKD) (1). This guideline led to a revolution in the detection and management of CKD. Two of the cornerstones of kidney disease diagnosis and management—proteinuria and decreased glomerular filtration rate (GFR)—had always relied heavily on laboratory support. Inevitably, the guideline was avidly read by laboratory scientists and clinicians, with dramatic changes in practice ensuing. Implementation of the guideline was facilitated by the fact that a simple equation, the Modification of Diet in Renal Disease (MDRD) Study equation, had been published several years previously. This equation enabled estimation of GFR from the serum creatinine concentration, in addition to basic demographic details routinely supplied to laboratories. For the first time, a kidney disease definition and staging system were in use and linked directly to detection and management, and there was a simple and practical laboratory test available for the objective categorization of patients.Publication of the guideline contributed to an explosion in research, clinical evidence, and debate, in addition to the publication of other guidelines in other countries. There were also problems. The influence of creatinine method bias on the estimated GFR (eGFR) was perhaps the paramount problem, together with concerns of overdetection among some clinicians as the scale of the CKD “epidemic” came to be appreciated. Through joint efforts of the laboratory and nephrology community, the problems of standardization have largely been resolved. Some observers still have concerns about so-called disease labeling, but there is general agreement that a low GFR is associated with increased risk, regardless of age, sex, ethnicity, or underlying disease.The evidence generated in the last decade has driven an increased recognition of the need to revise the guideline and for increased sophistication. The work …