of use of the term “end-stage,” because it causes fear of the unknown, provokes undue trauma, implies impending death, and is obsolete. The term “kidney failure” appeared to be less objectionable, although it still prompted concerns. Participants wanted more clarity about the severity of disease and prognosis, including quantitative descriptions, with the understanding that they would need to learn the meaning of the descriptions. For future discussions, it is important to include people living in low- and middleincome countries, racial and ethnic minorities, children living with kidney disease and their parents, and patients with experience with acute kidney diseases. Public comments and attendee survey. A review of the responses to the Scope of the Work and a survey of attendees prior to the conference revealed general agreement with the goal of standardizing nomenclature, acknowledging some challenges (Box 1). Most of the participating editors agreed that having a standardized nomenclature for kidney function and disease would help their journals, and that the language employed in scholarly journals should match that used when communicating with patients. However, important barriers to implementation were identified; in particular, several editors were concerned that they lacked the resources necessary to Damage Normal Increased risk Damage Glomerular filtration rate Glomerular filtration rate Kidney failure Death Complications Kidney disease • Duration ≤ 3 months = acute • Duration > 3 months = chronic Acute kidney injury • Change within 1 week Function Structure Outcome Duration Cause • a • b • c a b Figure 1 | Conceptual model and classification of kidney disease. (a) Factors associated with increased risk of kidney disease (blue), stages of disease (green), and complications (including death; purple). Horizontal arrows show transitions between stages (kidney outcomes). Solid arrows pointing from left to right show progression of kidney disease. Dashed arrowheads pointing from right to left show remission. Gray triangles show the continuous nature of changes in glomerular filtration rate and kidney damage. Reprinted from The Lancet, Volume 382, Eckardt KU, Coresh J, Devuyst O, et al. Evolving importance of kidney disease: from subspecialty to global health burden, Pages 158–169, Copyright 2013, with permission from Elsevier.11 (b) Domains for classification in kidney disease. Reprinted from American Journal of Kidney Diseases, Volume 61, Levey AS, Levin A, Kellum JA. Definition and classification of kidney diseases, Pages 686–688, Copyright 2013, with permission from the National Kidney Foundation, Inc.12 KDIGO conference report AS Levey et al.: KDIGO nomenclature for kidney function and disease 1120 Kidney International (2020) 97, 1117–1129 standardize nomenclature in accepted manuscripts owing to the time constraints of journal personnel. Consensus and the proposed KDIGO glossary Conference attendees reached general consensus for each of the 5 main questions posed (Table 1). Accordingly, a proposed glossary contains 5 corresponding sections and comprises specific items on which there was general agreement among conference participants (Table 3). For each section, the glossary includes preferred terms, abbreviations, descriptions, and terms to avoid, with acknowledgement that journals may choose which of the recommendations to implement, and that journal style will dictate when and how to abbreviate terms to be consistent with nomenclature for other diseases. Examples of the use of glossary terms are given in Supplementary Box S2. For each section, we briefly summarize the discussion at the conference and highlight areas of remaining uncertainty. Kidney function and disease. Attendees agreed that it would be preferable to use the term “kidney” rather than either “renal” or the prefix “nephro-” for general descriptions of kidney disease and function (Table 3, Part 1). This practice would be in alignment with patient preferences obtained in the focus groups. The rationale is that for English-language readers, especially lay people, “kidney” is more familiar Table 2 | Results from patient and caregiver focus groupsa Theme Subthemes Provoking and exacerbating undue trauma Fear of the unknown Denoting impending death Despair in having incurable or untreatable disease Premature labeling and assumptions Judgment Stigma and failure of self Frustrated by ambiguity Confused by medicalized language Lacking personal relevance Baffled by imprecision in meaning Opposed to obsolete terms Making sense of the prognostic enigma Conceptualizing level of kidney function Correlating with symptoms and life impact Predicting progression and need for intervention Mobilizing selfmanagement Confronting reality Enabling planning and preparation Taking ownership for change Learning medical terms for self-advocacy Educating others a From a qualitative synthesis of thematic analysis of 10 focus groups comprising 54 patients with chronic kidney disease (CKD, across all severities) and 13 caregivers from the United States, United Kingdom, and Australia initiated and funded by Kidney Disease: Improving Global Outcomes from March to May 2019 to discuss terms and concepts used for kidney health.9 Box 1 | Prevailing attitudes of medical professionals emerging from public review