Chronic kidney disease

Kidney
failure
Replacement
by dialysis and 
transplantation
Death
Complications
Potential antecedents of CKD
Stages of CKD
Consequences of CKD
Figure 1: Conceptual model for chronic kidney disease
Continuum of development, progression, and complications of chronic kidney disease (CKD) and strategies to improve outcomes. Thick arrows between circles 
represent development, progression, and remission of CKD. Complications refer to all complications of CKD, including complications of decreased glomerular 
fi ltration rate (GFR) and cardiovascular disease. Complications might also arise from adverse eff ects of interventions to prevent or treat the disease. Horizontal arrows 
pointing from left to right represent the progressive nature of CKD. Dashed arrowheads signify that remission is less frequent than progression. Modifi ed and 
reproduced, with permission, from references 1 and 4.

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Seminar
www.thelancet.com Vol 379 January 14, 2012 
167
disease from 1999 to 2006 were about 11·5% (4·8% in 
stages 1–2 and 6·7% in stages 3–5), and 47% in people 
older than 70 years, mostly because of reduced GFR.
29
Prevalence seems to be increasing particularly in older 
individuals, and partly because of an increasing 
prevalence of diabetes and hypertension.
30
Reports from 
other countries
8
show some variation but are mostly 
consistent with these results.
In the USA, the ratios of prevalence of chronic kidney 
disease to incidence and prevalence of treated kidney 
Duration >3 months on the basis of documentation 
or inference
Duration is necessary to distinguish chronic from acute 
kidney disease
• Clinical assessment can indicate duration
• Documentation of duration is not usually available in 
epidemiological studies