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Letters Chronic kidney disease definition

A stable definition of chronic kidney disease improves knowledge and patient care

BMJ 2013; 347 doi: (Published 18 September 2013) Cite this as: BMJ 2013;347:f5553
  1. Josef Coresh, professor1,
  2. Andrew S Levey, professor2,
  3. Adeera Levin, professor3,
  4. Paul Stevens, consultant nephrologist4
  1. 1Departments of Epidemiology, Medicine, and Biostatistics, Johns Hopkins University, Baltimore, MD 21287, USA
  2. 2Division of Nephrology, Tufts Medical Center, Boston, MA, USA
  3. 3Division of Nephrology, University of British Columbia, Canada
  4. 4Kent Kidney Care Centre, East Kent University Hospitals NHS Foundation Trust, UK
  1. coresh{at}

As co-chairs of the 2002 and 2012 guidelines on the definition and staging of chronic kidney disease (CKD) we wanted to clarify several areas of disagreement with the authors of the recent BMJ article.1

Firstly, the 2012 definition is the same as the 2002 one.2

Secondly, new data assembled through a global consortium including 50 cohorts and more than two million people overwhelmingly support an increased risk associated with the definition thresholds (estimated glomerular filtration rate <60 ml/min/1.73m2 and urine albumin to creatinine ratio >30 mg/g (>3 mg/mmol)) regardless of age, hypertension, and diabetes.3

Thirdly, CKD is associated not just with progression to end stage renal disease but with risk of concurrent complications (anaemia, hyperparathyroidism, hyperphosphataemia) and future events (acute kidney injury, cardiovascular disease, …

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