Chronic kidney disease definition and classification: no need for a rush to judgment

The unified approach to chronic kidney disease (CKD) as per the Kidney Disease Outcomes Initiative (KDOQI) guideline for the definition and classification of kidney disease provided a paradigm shift in the detection, evaluation, and stratification of what was a neglected clinical problem. The guideline, based on the then-available evidence, determined the problems, limitations, and gaps in the knowledge of the proposed approach. Since then, solutions to the identified problems have been sought, resolutions are in place or are forthcoming, and longitudinal and cohort studies have been undertaken to better define the epidemiology of the disease and its prognostic determinants. The guideline also fostered considerable debate on the precision of the glomerular filtration rate equations, the implications of mislabeling cases, and the large estimates of prevalent cases of CKD. Winearls and Glassock now propose a new staging of CKD, centered on its progression to end-stage renal disease. A systematic analysis of the data accrued, since the publication of the original guideline in 2002, is necessary for the consideration of any refinement or redesign of the current staging. The Kidney Disease: Improving Global Outcomes (KDIGO) has undertaken that initiative. There is no need for a rush to judgment.