A Decade After the KDOQI CKD Guidelines: A Perspective From Egypt

Abstract

disease (CKD) guidelines will be remembered as a turning point in the history of nephrology. The worldwide practical impact of the guidelines, which embodied the key concepts of precision and evidence, has been mimicked by no other resource in our specialty. They changed terminology, modified the kidney disease glossary, and provided a highly trusted reference for the diagnosis and management of CKD. Furthermore, the guidelines provoked regional interest in screening for the disease and optimized its targeted treatment in many parts of the world. I have been privileged to be part of KDIGO (Kidney Disease: Improving Global Outcomes), the international CKD initiative inspired in part by the KDOQI guidelines, since its inception. Having chaired the KDIGO work group focused on the implementation of clinical practice guidelines in the developing world, I have directly witnessed their impact in many countries. One of our initial concerns was the questionable ability of socioeconomically underprivileged countries to adopt many of the guideline recommendations. We were not surprised when our Knowledge, Attitude, and Practice (KAP) survey in 8 developing countries showed that only 50% of participants were using KDOQI guidelines and 25% were not using any guidelines. 2 Of the latter, 43% attributed that to unaffordable expenses and 28% “did not agree” with many statements.