In this issue of JAMA Internal Medicine, Liu et al 3 spotlight one of these. Nonetheless, these sweeping changes to the recommended conceptual and pragmatic approach to defining and managing CKD had some unanticipated and unintended adverse consequences. It offered a formal case definition where none had existed previously, a common language to describe the presence and severity of CKD, and a powerful organizing structure to guide clinical care, scientific research, and patient advocacy. The 2002 guideline was in many ways a breath of fresh air. Pew Center for Global Climate Change, Market Mechanisms for Greenhouse Gas Emission Reductions: Lessons for California. Greg Easterbrook, ‘Some Convenient Truths’, The Atlantic Monthly, September 2006, p30. Parliamentary Debates (Hansard), 16 August 2006, p 4751.

Almost 2 decades later, many of the practices recommended in this guideline have been fully integrated into clinical practice, such as using a prediction equation to estimate glomerular filtration rate (eGFR) rather than serum creatinine alone, an eGFR-based classification system to define and gage the severity of CKD, and a risk-based approach to managing CKD based on the level of eGFR and albuminuria. Al Gore, An Inconvenient Truth: the planetary emergency of global warming and what we can do about it, Rodale, 2006, p298. Stream and download audiobooks to your computer, tablet and iOS and Android.

Since its publication in 2002, the National Kidney Foundation (NKF)’s clinical practice guideline 2 on the evaluation, classification, and stratification of chronic kidney disease (CKD) dramatically altered how we think about kidney disease and how we care for people with this condition. Listen Free to Inconvenient Truth: The Planetary Emergency of Global Warming.

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