Levey AS et al. (2007) Chronic kidney disease as a global public health problem: approaches and initiatives—a position statement from Kidney Disease Improving Global Outcomes. Kidney Int 72: 247–259

Recommendations from the 2006 Kidney Disease Improving Global Outcomes (KDIGO) Controversies Conference on 'Definition and Classification of Chronic Kidney Disease' (CKD) were published in Kidney International recently. The two main topics addressed at the conference were 'Classification, surveillance and public policy for CKD', and 'Associations of CKD with chronic diseases'.

Conference participants decided that the current CKD classification system based on estimated glomerular filtration rate is clear and simple, and that further clinical information should not be added to it at present. They recommended that a targeted screening program for CKD be introduced in all countries, directed at individuals with hypertension, diabetes or cardiovascular disease. CKD screening should include both a urine test for proteinuria and a blood test to determine creatinine level for estimation of glomerular filtration rate.

Other recommendations included the following: all countries should introduce surveillance programs to monitor stages 4–5 CKD; governments in all countries should adopt a public health policy for CKD, and should support screening, surveillance and public awareness programs; patients with HIV or hepatitis C virus should be screened for CKD when diagnosed and annually thereafter; patients with cancer should be screened for CKD at diagnosis and when cancer treatment is initiated or changed; and patients with stage 5D CKD should be vaccinated against influenza, hepatitis B and pneumococcus. Recommendations for future studies in CKD were also made.