Markers of kidney damage include a wide range of biomarkers originating in the kidney: albuminuria or proteinuria fluid, electrolyte, and acid-base disorders urine sediment abnormalities imaging abnormalities pathologic abnormalities and a history of kidney transplantation (so that kidney transplant recipients will be considered to have CKD, irrespective of functional or structural abnormalities of the transplant).Ĭlassification of AKD, like AKI and CKD, includes cause of disease, which directs cause-specific treatment. The functional and structural criteria for CKD include GFR <60 mL/min/1.73 m 2 or markers of kidney damage, respectively, with duration ≥3 months. The structural criteria for AKI and the criteria for the resolution for AKI are not included in the KDIGO guideline, and are likely to be considered by a future KDIGO AKI guideline update workgroup. The functional criteria for AKI include a rise in S cr within 2–7 days or oliguria for ≥4 h, with duration <3 months. The criteria for CKD are intended to address most presentations of chronic diseases and disorders, but the criteria for AKI are intended to be more restrictive and not to address all presentations of acute diseases and disorders. The criteria for AKI and CKD are as defined by the existing KDIGO guidelines. People without AKI, AKD, or CKD are classified as NKD.įigure 2 details the conceptual overlap and diagnostic criteria for each disorder, according to duration and measures of function and structure. NKD represents no known KD, defined as either no abnormalities in kidney structure or function or abnormalities without implications for health. AKD without AKI is a subgroup of AKD, in which there are either abnormalities in kidney structure or abnormalities in kidney function that are less severe than in AKI or that do not develop as rapidly as in AKI. AKI may occur either at the onset of AKD or after the onset of AKD. AKI is a subgroup of AKD, defined by abnormalities in kidney function over 6 h–1 week. By definition, AKD precedes CKD, but AKD may also be superimposed on preexisting CKD, either due to another disease or due to an exacerbation of the same disease. AKD and CKD differ from each other by the duration of disease, either <3 or ≥3 months, respectively. In this brief review, I will summarize the evidence review presented at the consensus conference, the proposed KDIGO definition and classification of AKD, and the spectrum of AKI, AKD, and CKD.įigure 1 provides a conceptual framework for the time course of the spectrum of KD, defined as abnormalities in kidney structure or function, with implications for health. The consensus of the conference attendees was to retain the KDIGO definition of AKD, recommend a classification of KD consistent with the KDIGO AKI and CKD definitions, provide general recommendations on evaluation and management, and outline a research agenda. In 2020, KDIGO convened a consensus conference to review recent evidence on the epidemiology of AKD and more fully discuss these topics. The report conceived of AKI as preceding AKD in most cases proposed a limitation for the duration of AKI as 7 days, with persistence beyond this time as AKD and suggested a classification of AKD according to the preceding AKI stage. In 2017, the Acute Dialysis Quality Initiative (ADQI) 16 report proposed an alternative definition and a classification of AKD, as well as a revised definition of AKI. Because of the absence of a substantial evidence base on the epidemiology of AKD, the KDIGO guideline did not propose recommendations for classification or management. The guideline conceived of AKD as a more heterogeneous group of disorders than AKI, and considered AKI as a subset of AKD. The KDIGO AKI guideline of 2011 suggested an operational definition of AKD designed to address this gap and to harmonize the criteria for the spectrum of clinical presentations of AKI, AKD, and CKD, and also the absence of these presentations as no known kidney diseases or disorder (NKD).
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