Chronic kidney disease

Seminar
www.thelancet.com Vol 379 January 14, 2012 
177
programmes for kidney disease have been launched in 
many locations, which confi rm a high prevalence of 
decreased GFR and albuminuria in association with a 
high burden of risk factors for cardiovascular disease.
140
However, studies
141–144
have suggested that screening is 
not cost eff ective for reducing kidney failure or all-cause 
mortality except in high-risk populations—eg, old 
people with diabetes or hypertension. With a wide range 
of outcomes and a focus on high-risk target populations, 
cost-eff ectiveness of screening might be improved.
Chronic kidney disease is one of several chronic 
diseases aff ecting mostly older people and leading to a 
substantially increased risk of cardiovascular disease. 
Coordination of public health eff orts for chronic kidney 
disease and other chronic diseases will probably be the 
most effi
cient strategy. Reorganisation of delivery of care 
to treat older people and others with various chronic 
diseases effi
ciently will probably be necessary, as will 
cooperation at all levels of governmental and private 
organisations. Assessment of the eff ectiveness of public 
health strategies will be important to guide progress.
Contributors
ASL did the literature search and wrote the fi rst draft of the Seminar 
with assistance from JC. Both authors interpreted the retrieved 
publications and planned and revised the Seminar.
Confl icts of interest
ASL has received payment for editorial board membership from the 
National Kidney Foundation (NKF), and grant support from NKF and 
Amgen. JC declares that he has no confl icts of interest.
Acknowledgments
We thank Mark J Sarnak, Katrin L Uhlig, Lesley A Stevens, 
Ashish Upadhyay, and Joe Eustace for reviewing early versions of the 
Seminar; Aghogho Okparavero for helping to prepare the Seminar; and 
Stephen Juraschek and Brad C Astor for providing data for fi gure 4.
References
1 
National Kidney Foundation. K/DOQI clinical practice guidelines 
for chronic kidney disease: evaluation, classifi cation, and 
stratifi cation. Am J Kidney Dis 2002; 39 (2 suppl 1): S1–266.
2 
Levey AS, Coresh J, Balk E, et al, for the National Kidney 
Foundation. National Kidney Foundation practice guidelines for 
chronic kidney disease: evaluation, classifi cation, and stratifi cation. 
Ann Intern Med 2003; 139: 137–47.
3 
Levey AS, Eckardt KU, Tsukamoto Y, et al. Defi nition and 
classifi cation of chronic kidney disease: a position statement from 
Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int 
2005; 67: 2089–100.
4 
Levey AS, Stevens LA, Coresh J. Conceptual model of CKD: 
applications and implications. Am J Kidney Dis 2009;