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Report of a Kidney Disease: Improving Global Outcomes (KDIGO) Consensus Conference

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Report of a Kidney Disease: Improving Global Outcomes (KDIGO) Consensus Conference Nomenclature for Kidney Function and Disease: Report of a Kidney Disease: Improving Global Outcomes (KDIGO) Consensus Conference Andrew S. Levey 1, Kai-Uwe Eckardt 2, Nijsje M. Dorman 3, Stacy L. Christiansen 4, Ewout J. Hoorn 5, Julie R. Ingelfinger 6, Lesley A. Inker 1, Adeera Levin 7, Rajnish Mehrotra 8, Paul M. Palevsky 9, Mark A. Perazella 10 , Allison Tong 11 , Susan J. Allison 12 , Detlef Bockenhauer 13 , Josephine P. Briggs 14 , Jonathan S. Bromberg 15 , Andrew Davenport 16 , Harold I. Feldman 17 , Denis Fouque 18 , Ron T. Gansevoort 19 , John S. Gill 20 , Eddie L. Greene 21 , Brenda R. Hemmelgarn 22 , Matthias Kretzler 23 , Mark Lambie 24 , Pascale H. Lane 25 , Joseph Laycock 26 , Shari Leventhal 27 , Michael Mittelman 28 , Patricia Morrissey 29 , Marlies Ostermann 30 , Lesley Rees 31 , Pierre Ronco 32 , Franz Schaefer 33 , Jennifer St. Clair Russell 34 , Caroline Vinck 35 , Stephen B. Walsh 36 , Daniel E. Weiner 1, Michael Cheung 37; Michel Jadoul 38, Wolfgang C. Winkelmayer 39 1 Division of Nephrology, Tufts Medical Center, Boston, MA, USA 2 Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Berlin, Germany 3 Managing Editor , AJKD 4 Managing Editor , JAMA 5 Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus Medical Center, University Medical Center Rotterdam, The Netherlands 6 Harvard Medical School, Boston, Mass; Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA 7 Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada 8 David S. and Nayda Utterberg Endowed Professor; Kidney Research Institute; and Harborview Medical Center Division of Nephrology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA 9 Renal Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA 10 Section of Nephrology, Yale University School of Medicine, New Haven, CT, USA; Veterans Affairs Medical Center, West Haven, CT, USA 11 Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia 12 Chief Editor , Nature Reviews Nephrology 13 Renal Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; Department of Renal Medicine, University College London, London, UK. 14 Editor-in-Chief , JASN , Washington, DC, USA 15 Department of Surgery, Division of Transplantation, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD, USA 16 Royal Free London NHS Foundation Trust, London, UK 17 Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, PA, USA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, PA, USA; Renal Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, PA, USA 18 Department of Nephrology, Centre Hospitalier Lyon Sud, Lyon, France. 19 Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands 20 Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada 21 Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA 22 Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada 23 Department of Internal Medicine, Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA 24 Institute for Science and Technology in Medicine, Keele University, Crewe, UK 25 Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA 26 Managing Editor , Pediatric Nephrology 27 Executive Editor, American Society of Nephrology, Washington, DC 20005 28 American Living Organ Donor Fund, Philadelphia, PA, USA 29 Executive Managing Editor, Kidney International 30 Department of Critical Care, King's College London, Guy's & St Thomas' Hospital, London, UK 31 Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK 32 Sorbonne Université, and Institut National de la Santé et de la Recherche Médicale (Inserm), Unité Mixte de Recherche UMR_S1155, Paris, France; Hôpital de jour - Néphrologie, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France. 33 Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg University, Heidelberg, Germany 34 National Kidney Foundation, New York, NY, USA 35 Managing Editor, Nephrology Dialysis Transplantation 36 Centre for Nephrology, University College London, London, UK 37 KDIGO, Brussels, Belgium 38 Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium 2 39 Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA 3 Running title: Nomenclature for Kidney Function and Disease: A KDIGO Consensus report Word count: 3699 Keywords: acute kidney disease; acute kidney injury; chronic kidney disease; kidney disease; kidney failure; kidney function; kidney measures; nomenclature; patient-centeredness, precision medicine Correspondence: Andrew S. Levey Division of Nephrology, Tufts Medical Center Box 391, 850 Washington Street, Boston, MA 02111, USA Email: [email protected] Kai-Uwe Eckardt Department of Nephrology and Medical Intensive Care Charité—Universitätsmedizin Berlin Augustenburger Platz 1, Berlin 13353, Germany Email: [email protected] 4 Abstract The worldwide burden of kidney disease is rising, but public awareness remains limited, underscoring the need for more effective communication by stakeholders in the kidney health community. Despite this need for clarity, the nomenclature for describing kidney function and disease lacks uniformity. In June 2019, KDIGO convened a Consensus Conference with the goal of standardizing and refining the nomenclature used in the English language to describe kidney function and disease, and of developing a glossary that could be used by journals in scientific publications. Guiding principles of the conference were that the revised nomenclature should be patient-centered, precise, and consistent with nomenclature used in the KDIGO guidelines. Conference attendees reached general consensus on the following recommendations: 1) To use “kidney” rather than “renal” or “nephro” when referring to kidney disease and kidney function; 2) To use “kidney failure” with appropriate descriptions of presence or absence of symptoms, signs, and treatment rather than “end-stage” kidney disease; 3) To use the KDIGO definition and classification of acute kidney diseases and disorders (AKD) and acute kidney injury (AKI) rather than alternative descriptions to define and classify severity of AKD and AKI; 4) To use the KDIGO definition and classification of chronic kidney disease (CKD) rather than alternative descriptions to define and classify severity of CKD; and 5) To use specific kidney measures, such as albuminuria or decreased glomerular filtration rate (GFR), rather than “abnormal or reduced kidney function” to describe alterations in kidney structure and function. A proposed 5- part glossary contains specific items for which there was general agreement. Conference attendees acknowledged limitations of the recommendations and glossary, but considered that standardizing scientific nomenclature is essential for improving communication. 5 Introduction The worldwide burden of kidney disease is rising, but public awareness remains limited, underscoring the need for effective communication by stakeholders in the kidney health community.1-4 Despite this need for clarity, the nomenclature for describing kidney function and disease lacks uniformity. Two decades ago, a survey of hundreds of published articles and meeting abstracts reported a broad array of overlapping, confusing terms for chronic kidney disease (CKD) and advocated adoption of unambiguous terminology. 5 Nevertheless, terms flagged by that analysis as problematic, such as “chronic renal failure” and “pre-dialysis,” still appear in current-day publications. A coherent, shared nomenclature could influence communication at all levels, including not only greater appreciation of the burden of disease, but also improved understanding about how patients feel about their disease, more effective communication between kidney disease specialists and other clinicians, more straightforward comparison and integration of datasets, better recognition of gaps in knowledge for future research, and more comprehensive public health policies for acute and chronic kidney diseases. The international organization Kidney Disease: Improving Global Outcomes (KDIGO) has developed guidelines promulgating definitions and classifications for acute kidney injury (AKI), acute kidney diseases and disorders (AKD), and CKD, and guidelines for their evaluation and management.6,7 Developing consistent, patient-centered, and precise descriptions of kidney function and disease in the scientific literature is an important objective that KDIGO is now pursuing to align communication in clinical practice, research, and public
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