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A cross-sectional study of U.S. adult participants with diabetes in the National Health and Nutrition Examination Survey assessed national trends in diabetes treatment and risk-factor control from 1999 through 2018. After more than a decade of progress, glycemic and blood-pressure control declined, while lipid control plateaued.

Chronic kidney disease is a general term for heterogeneous disorders affecting kidney structure and function. The 2002 guidelines for definition and classification of this disease represented an important shift towards its recognition as a worldwide public health problem that should be managed in its early stages by general internists. Disease and management are classified according to stages of disease severity, which are assessed from glomerular filtration rate (GFR) and albuminuria, and clinical diagnosis (cause and pathology). Chronic kidney disease can be detected with routine laboratory tests, and some treatments can prevent development and slow disease progression, reduce complications of decreased GFR and risk of cardiovascular disease, and improve survival and quality of life. In this Seminar we discuss disease burden, recommendations for assessment and management, and future challenges. We emphasise clinical practice guidelines, clinical trials, and areas of uncertainty.

In the past decade, kidney disease diagnosed with objective measures of kidney damage and function has been recognised as a major public health burden. The population prevalence of chronic kidney disease exceeds 10%, and is more than 50% in high-risk subpopulations. Independent of age, sex, ethnic group, and comorbidity, strong, graded, and consistent associations exist between clinical prognosis and two hallmarks of chronic kidney disease: reduced glomerular filtration rate and increased urinary albumin excretion. Furthermore, an acute reduction in glomerular filtration rate is a risk factor for adverse clinical outcomes and the development and progression of chronic kidney disease. An increasing amount of evidence suggests that the kidneys are not only target organs of many diseases but also can strikingly aggravate or start systemic pathophysiological processes through their complex functions and effects on body homoeostasis. Risk of kidney disease has a notable genetic component, and identified genes have provided new insights into relevant abnormalities in renal structure and function and essential homoeostatic processes. Collaboration across general and specialised health-care professionals is needed to fully address the challenge of prevention of acute and chronic kidney disease and improve outcomes.

This study presents an equation for estimating the glomerular filtration rate that uses both creatinine and cystatin C. It performs better than equations with either marker alone and is potentially useful for confirming chronic kidney disease. Clinical assessment of kidney function is part of routine medical care for adults. 1 More than 80% of clinical laboratories now report an estimated glomerular filtration rate (GFR) when serum creatinine is measured. 2 Despite standardization of serum creatinine assays, GFR estimates remain relatively imprecise 3 owing to variation in non-GFR determinants of serum creatinine, which may be affected in both acute and chronic illness. 1 Such imprecision can potentially result in the misclassification of patients whose estimated GFR is less than 60 ml per minute per 1.73 m 2 of body-surface area as having chronic kidney disease, leading to unnecessary diagnostic and therapeutic interventions. . . .

In this meta-analysis of 16 studies, investigators evaluated the use of cystatin C, alone or with creatinine, to calculate the estimated glomerular filtration rate (eGFR). Measurement of cystatin C improved the prediction of outcomes in chronic kidney disease. The estimated glomerular filtration rate (eGFR) is the clinical standard for the assessment of kidney function. 1 – 3 The eGFR thresholds for the definition and staging of chronic kidney disease are based on risk, 3 but measurement of creatinine to determine the eGFR has limitations in risk prediction, particularly in patients with reduced muscle mass. 4 Cystatin C has received much attention as an alternative filtration marker with stronger and more linear risk relationships than creatinine. 5 – 7 Several studies have suggested that the addition of cystatin C measurements to creatinine measurements in calculating the eGFR significantly improves the risk classification for death, cardiovascular . . .

This study examined risk associations calibrated to the U.S. population-level incidence of end-stage renal disease and death and projected long-term incidences of ESRD. Risk projections among nondonors were lower than 15-year observed risks after donation. Nearly 30,000 people worldwide become living kidney donors each year. 1 – 3 Traditionally, living donors have been selected on the basis of an absence of risk factors for poor outcomes after donation and without a comprehensive assessment of individualized long-term risk. Although kidney donation is considered to be safe in healthy, low-risk persons, donation has lifelong implications, and the most direct effect may be an increased long-term risk of end-stage renal disease (ESRD). 4 – 7 A tool to predict a donor candidate’s long-term risk of ESRD that incorporates the combined effect of multiple demographic and health characteristics before donation could help make . . .

In this letter, the authors report that chronic kidney disease related to diabetes has become increasingly common both in the general population and among hospitalized urban patients in China, a finding that is preceded by decades of increasing prevalence of type 2 diabetes. To the Editor: Diabetes is the leading cause of end-stage kidney disease worldwide, though glomerulonephritis has been the more predominant cause in developing countries. 1 We hypothesized that the surging prevalence of diabetes in developing countries may have a substantial effect on the observed spectrum of chronic kidney disease. To evaluate trends in chronic kidney disease related to diabetes or to glomerulonephritis, we used two resources — one that tracks hospitalized persons and another that tracks the general population in China. To track hospitalized persons, we used the Hospital Quality Monitoring System, a mandatory patient-level national database for hospital accreditation, under . . .

This community-based study of nondiabetic adults compared the prognostic value of glycated hemoglobin and fasting glucose for identifying persons at risk for clinical outcomes such as diabetes. As compared with fasting glucose, glycated hemoglobin was similarly associated with the risk of diabetes and more strongly associated with the risks of cardiovascular disease and death from any cause, adding to data about the use of glycated hemoglobin as a diagnostic measure. As compared with fasting glucose, glycated hemoglobin was similarly associated with the risk of diabetes and more strongly associated with the risks of cardiovascular disease and death from any cause, adding to data about the use of glycated hemoglobin as a diagnostic measure. Fasting glucose is the standard measure used for the diagnosis of diabetes in the United States. 1 , 2 Historically, glycated hemoglobin has been recommended only for the determination of glucose control among persons who have already received the diagnosis of diabetes. New clinical practice recommendations from the American Diabetes Association advocate the use of glycated hemoglobin in the diagnosis of diabetes, largely on the basis of the established association between glycated hemoglobin and microvascular disease. 3 Compared with fasting glucose, glycated hemoglobin has several advantages as a diagnostic test: it has higher repeatability, 4 – 6 can be assessed in the nonfasting state, and . . .

The definition and classification for chronic kidney disease was proposed by the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) in 2002 and endorsed by the Kidney Disease: Improving Global Outcomes (KDIGO) in 2004. This framework promoted increased attention to chronic kidney disease in clinical practice, research and public health, but has also generated debate. It was the position of KDIGO and KDOQI that the definition and classification should reflect patient prognosis and that an analysis of outcomes would answer key questions underlying the debate. KDIGO initiated a collaborative meta-analysis and sponsored a Controversies Conference in October 2009 to examine the relationship of estimated glomerular filtration rate (GFR) and albuminuria to mortality and kidney outcomes. On the basis of analyses in 45 cohorts that included 1,555,332 participants from general, high-risk, and kidney disease populations, conference attendees agreed to retain the current definition for chronic kidney disease of a GFR <60ml/min per 1.73m2 or a urinary albumin-to-creatinine ratio >30mg/g, and to modify the classification by adding albuminuria stage, subdivision of stage 3, and emphasizing clinical diagnosis. Prognosis could then be assigned based on the clinical diagnosis, stage, and other key factors relevant to specific outcomes. KDIGO has now convened a workgroup to develop a global clinical practice guideline for the definition, classification, and prognosis of chronic kidney disease.

In the coming years, estimates of the glomerular filtration rate (GFR) may replace the measurement of serum creatinine as the primary tool for the assessment of kidney function. Indeed, many clinical laboratories already report estimated GFR values whenever serum creatinine is measured. This review considers current methods of measuring GFR and GFR-estimating equations and their strengths and weaknesses as applied to chronic kidney disease. In the coming years, estimates of the glomerular filtration rate (GFR) may become the primary tool for the assessment of kidney function. This review considers current methods of measuring GFR and GFR-estimating equations and their strengths and weaknesses as applied to chronic kidney disease. Many organizations recommend the use of equations that estimate the glomerular filtration rate (GFR) to facilitate the detection, evaluation, and management of chronic kidney disease. 1 – 11 Indeed, many clinical laboratories already report estimated GFR values whenever the serum creatinine level is measured. In this review, we discuss the strengths and weaknesses of current methods of measuring and estimating GFR as applied to chronic kidney disease. Chronic Kidney Disease Chronic kidney disease has recently been recognized as a public health problem; it is estimated that by 2030, more than 2 million people in the United States will need dialysis or transplantation . . .