and participant survey Agreement with goal of standardizing nomenclature, with acknowledgment of challenges Regarded multiplicity of terms and lack of adherence to established definitions as confusing and potentially leading to errors Anticipated that a standardized nomenclature would help foster consistency in trial design, execution, and reporting Judged consistency between terms used in scholarly and patient communities to be an important goal, but not one overriding the need for precision and efficiency Journal editors strongly agreed that having a more standardized nomenclature for kidney disease would be useful for their journals, but they anticipated time constraints of journal personnel to be the biggest barrier to implementation Qualified endorsement of replacing “renal” with “kidney” Felt that foregrounding “kidney” would be easier for patients and their families Perceived a greater likelihood of raising awareness, attracting funding, and influencing public policy with consistent use of“kidney” Cautioned against a wholesale switch because “renal” may be less awkward in some contexts and may be necessary in others (e.g., ESRD as a CMS definition) Dissatisfaction with “end-stage” as a descriptor of kidney disease Recognized that this wording can be demoralizing and stigmatizing for patients Considered the implication of imminent death to be outdated Frustrated by imprecision in its use (ranging from being a synonym for dialysis patients to a descriptor of patients with kidney failure with or without kidney replacement therapy) Recognition of the need for ongoing attention to nomenclature issues Noted that standardization of nomenclature is dependent on uptake of consensus definitions B where definitions are in flux or are more contentious, standardization of that nomenclature set may be premature B enhancing adoption of definitions requires continued effort Highlighted the need for harmonization with ongoing, broader-scope ontology efforts Expected that improved understanding of molecular mechanisms will lead to more-precise definitions and nomenclature CMS, Centers for Medicare & Medicaid Services; ESRD, end-stage renal disease. AS Levey et al.: KDIGO nomenclature for kidney function and disease KDIGO conference report Kidney International (2020) 97, 1117–1129 1121 than “renal” and “nephro-,” which tend to be used in more technical contexts. In addition, it is simpler, and using a single term rather than multiple, redundant terms is less likely to cause confusion. For specific kidney functions, diseases, or syndromes, the established terms derived from Latin (“renal”) or Greek (“nephro-”) would continue to be used. Attendees acknowledged that English is not the native language for many authors of publications in the English-language literature; thus, editors should anticipate that discussion with authors may be necessary in implementing this recommendation, rather than simply substituting one word for another within a manuscript. Although classification of cause of kidney disease was not considered, attendees agreed that the cause of AKI, AKD, and CKD should be indicated whenever possible, either as known, presumed, or unknown, and that the method for ascertainment and attribution of cause should be specified. Cause should not be inferred only from the presence of comorbid conditions; for example, it should not be inferred that CKD in people with diabetes is always due to diabetes. Kidney failure. Attendees were nearly unanimous in their agreement that use of the term “end-stage” should be avoided for describing a defined stage of kidney disease or people in that stage (Table 3, Part 2). The rationale is that the term is not well defined or consistently used, except for administrative purposes. For example, in the United States, end-stage renal disease (ESRD) is specified in federal statute as “. . . a medical condition in which a person’s kidneys cease functioning on a permanent basis leading to the need for a regular course of long-term dialysis or a kidney transplant to maintain life. Beneficiaries may become entitled to Medicare based on ESRD. Benefits on the basis of ESRD are for all covered services, not only those related to the kidney failure condition.” 24 In these circumstances, it refers to an entitlement to treatment for a condition, rather than the condition itself. Similarly, the term is frequently used to describe patients with CKD treated by dialysis or transplantation, and so does not apply to people with the same condition who do not receive treatment, whether by choice, lack of recognition of the disease, or unavailability of the treatment. Furthermore, as expressed in the patient and caregiver focus groups, it does not accurately define a group of people who can survive for years with treatment; it misleadingly implies that the end of life is near and it may be associated with a stigma even in people who are not at the end of life. In the chronic setting, the term “kidney failure” was recommended, as defined in the KDIGO CKD guideline (glomerular filtration rate [GFR] 3 months, are unchanged since the 2002 KDOQI CKD guideline.29 The classification of CKD was updated by the 2012 KDIGO CKD guideline to include KDIGO conference report AS Levey et al.: KDIGO nomenclature for kidney function and disease 1122 Kidney International (2020) 97, 1117–1129 Table 3 (Parts 1–5) |