Nephrologists Sans Frontières: Chronic kidney disease in Japan

Abstract

The explosive increase in the number of chronic kidney disease patients has become the biggest problem in the nephrology community worldwide. The guidelines proposed by the Kidney Disease Outcomes Quality Initiative for the definition of chronic kidney disease seem generally to be well accepted. An important element of this definition is a glomerular filtration rate (GFR) less than 60 ml per minute per 1.73 m2 body surface area. Although the definition further includes kidney damage as defined by structural and functional abnormalities, the definite number of GFR 60 is simple and impressive in clinical practice. The most important point in the guidelines is adoption of the estimated GFR based on serum creatinine rather than a measured GFR based, for example, on creatinine clearance; the prediction equation from the Modification of Diet in Renal Disease Study (AS Levey et al. J Am Soc Nephrol 2001; 11: 155A, abstr.) is recommended for the estimation of GFR (see more details at http://www.kdoqi.org). This is very practical and convenient for nephrologists, at whom the Kidney Disease Outcomes Quality Initiative seems to aim. Acceptance of this simple guideline has made it possible to estimate the number of chronic kidney disease patients in each region or country around the world. Knowing the prevalence of chronic kidney disease is critically important for nephrologists and governments in developing future plans for clinical practice and public health.