Kidney transplantation is the treatment of choice for endstage renal disease.The evaluation of graft function is mandatory in the management of renal transplant recipients.Glomerular filtration rate(GFR),is generally ...Kidney transplantation is the treatment of choice for endstage renal disease.The evaluation of graft function is mandatory in the management of renal transplant recipients.Glomerular filtration rate(GFR),is generally considered the best index of graft function and also a predictor of graft and patient survival.However GFR measurement using inulin clearance,the gold standard for its measurement and exogenous markers such as radiolabeled isotopes(51Cr EDTA,99 mTc DTPA or 125 I Iothalamate) and non-radioactive contrast agents(Iothalamate or Iohexol),is laborious as well as expensive,being rarely used in clinical practice.Therefore,endogenous markers,such as serum creatinine or cystatin C,are used to estimate kidney function,and equations using these markers adjusted to other variables,mainly demographic,are an attempt to improve accuracy in estimation of GFR(e GFR).Nevertheless,there is some concern about the inability of the available e GFR equations to accurately identify changes in GFR,in kidney transplant recipients.This article will review and discuss the performance and limitations of these endogenous markers and their equations as estimators of GFR in the kidney transplant recipients,and their ability in predicting significant clinical outcomes.展开更多
目的:探讨机器人辅助下肾癌肾部分切除术(RAPN)后肾细胞癌(RCC)患者肾功能保留和达成三连胜结局的影响因素,为指导术前评估、术后治疗和远期随访提供依据。方法:回顾性分析行机器人辅助下肾部分切除术的111例RCC患者的临床资料,根据是...目的:探讨机器人辅助下肾癌肾部分切除术(RAPN)后肾细胞癌(RCC)患者肾功能保留和达成三连胜结局的影响因素,为指导术前评估、术后治疗和远期随访提供依据。方法:回顾性分析行机器人辅助下肾部分切除术的111例RCC患者的临床资料,根据是否达成三连胜结局分为三连胜组(n=73)和非三连胜组(n=38),根据术前和术后24 h估计肾小球滤过率(eGFR)变化分为术后24 h eGFR下降≤10%组(n=85)和术后24 h eGFR下降>10%组(n=26)。分别比较2组患者年龄、性别、美国麻醉医师协会(ASA)评分、体质量指数(BMI)、高血压、糖尿病、术前eGFR、术后24 h eGFR变化百分率、肾门部肿瘤、肿瘤背腹侧位置、肿瘤最大径、手术路径、热缺血时间(WIT)、估计出血量(EBL)、肿瘤病理类型、肿瘤TNM分期、RENAL评分、PADUA评分、中心性指数(C-index)、肾脏肿瘤侵袭指数(RTII)和肿瘤接触面积(CSA)。多因素Logistic回归分析患者达成三连胜和术后24 h eGFR变化下降>10%的影响因素,多元线性回归分析影响患者术后24 h eGFR变化的影响因素。结果:111例患者中共73例患者达成三连胜结局。单因素分析,三连胜组和非三连胜组患者年龄、高血压、肿瘤最大径、RENAL评分、PADUA评分、C-index、RTII、CSA和EBL比较差异有统计学意义(P<0.05)。多因素Logistic分析,EBL是RAPN术后患者未达成三连胜结局的独立影响因素(OR=1.006,95%CI=1.001-1.011,P=0.020)。术后24heGFR下降>10%组和术后24 h eGFR下降≤10%组患者肿瘤最大径、RENAL评分、PADUA评分、C-index、RTII、CSA、WIT、EBL和肿瘤TNM分期比较差异有统计学意义(P<0.05)。多因素Logisitc回归分析,RTII是患者术后24 h eGFR下降>10%的独立影响因素(OR=4.442,95%CI=1.049-18.806,P=0.043)。肿瘤最大径、RENAL评分、PADUA评分、C-index、RTII、CSA、WIT、EBL、肿瘤TNM分期与术后eGFR变化无明显关联,RTII与术后24 h eGFR变化呈负相关关系(B=-7.204,95%CI=-14.305--0.102,P=0.047)。结论:EBL是RAPN术后患者未能达成三连胜结局的独立影响因素,RTII与RAPN术后24 h eGFR变化呈负相关关系。展开更多
目的探讨单侧上尿路梗阻解除前后肾皮质厚度(RCT)与肾小球滤过率(GFR)的关系。方法选取2015年7月-2016年6月该院泌尿外科收治的63例上泌尿道梗阻患者为研究对象。其中,男34例,女29例,年龄22~73(52.21±11.56)岁;手术方式:输尿管镜碎...目的探讨单侧上尿路梗阻解除前后肾皮质厚度(RCT)与肾小球滤过率(GFR)的关系。方法选取2015年7月-2016年6月该院泌尿外科收治的63例上泌尿道梗阻患者为研究对象。其中,男34例,女29例,年龄22~73(52.21±11.56)岁;手术方式:输尿管镜碎石+取石术24例,一期经皮肾造瘘+二期经皮肾镜取石术(PCNL)21例,一期PCNL 18例。采用腹部增强CT、单光子发射计算机断层(SPECT)扫描分别测量RCT和GFR,根据术前患肾GFR情况分为3组:A组(中度肾损害,15.0 ml/min≤GFR<30.0 ml/min)、B组(重度肾损害,7.5 ml/min≤GFR<15.0 ml/min)、C组(极重度肾损害,GFR<7.5 ml/min),比较3组的手术前后的GFR变化。采用简单线性相关分析A和B组患者术前RCT与各指标的相关性。结果 9例患者因肾积水严重未测量RCT,患者的术前RCT>10 mm 20例,5~10 mm 23例,<5 mm 11例,平均值为(10.75±4.91)mm。A组术前RCT明显高于B组,差异有统计学意义(P<0.05)。3组患者术后1和9个月的GFR均明显高于同组术前,差异均有统计学意义(P<0.05)。A组术后1和9个月的GFR均明显高于另外两组,B组术后9个月的GFR明显高于C组,差异均有统计学意义(P<0.05),但术后1个月B组和C组的GFR差异无统计学意义(P>0.05)。B组术后1个月的GFR恢复值明显低于另外两组,差异有统计学意义(P<0.05),3组术后9个月的GFR恢复值比较差异无统计学意义(P>0.05)。术前RCT与术前GFR(r=0.613)、术后1个月GFR(r=0.697)及恢复值(r=0.552)、术后9个月GFR(r=0.589)及恢复值(r=0.488)均呈显著正相关,差异有统计学意义(P<0.05)。结论解除上泌尿道梗阻后患者的肾功能得到不同程度的恢复,即使是极重度肾功能损伤者,多数均能挽回患肾。术前RCT能有助于判断围手术期的肾功能,尤其是术后肾功能恢复情况。展开更多
目的以同位素扫描肾图为金标准考察肾脏增强CT动脉期、静脉期和实质期图像分别用于测量肾功能的可行性,并初步比较其准确性。方法前瞻性纳入52例单侧肾脏病变患者行常规肾脏增强CT检查和99mTc-DTPA肾动态显像Gates法肾功能测量。分别根...目的以同位素扫描肾图为金标准考察肾脏增强CT动脉期、静脉期和实质期图像分别用于测量肾功能的可行性,并初步比较其准确性。方法前瞻性纳入52例单侧肾脏病变患者行常规肾脏增强CT检查和99mTc-DTPA肾动态显像Gates法肾功能测量。分别根据肾脏增强CT动脉期、静脉期和实质期的图像计算病肾的体积和CT强化值的乘积(Products of Volume and Enhancement,VE),用来描述病变肾脏的肾功能。以Gates法所测病变肾脏的肾小球滤过率(Gates-GFR)为金标准,用Pearson相关分析来评估各个CT期相VE和Gates-GFR的相关性,并依据相关系数的大小初步判断其准确性。结果肾脏动脉期、静脉期和实质期体积和强化值乘积(A-VE、V-VE、P-VE)均与Gates-GFR有较好的相关性,相关系数r分别为0.793、0.848和0.927,P值均小于0.001。结论肾脏增强CT三期扫描所得VE都和Gates-GFR呈正相关,均有可能用来评估肾功能,实质期可能更为准确。展开更多
AIM: To evaluate determinants of inflammatory markers in chronic renal failure patients according to the level of glomerular filtration rate. METHODS: One hundred fifty four patients(Age; 44 ± 06 years, male/fema...AIM: To evaluate determinants of inflammatory markers in chronic renal failure patients according to the level of glomerular filtration rate. METHODS: One hundred fifty four patients(Age; 44 ± 06 years, male/female; 66/88) with chronic renal failure(CRF) were divided into 6 groups according to the National Kidney Foundation(NKF) classification. They included 28 primary stage renal failure patients(CRF 1), 28 moderate stage renal failure patients(CRF 2),28 severe stage renal failure patients(CRF 3), 18 endstage renal failure patients(CRF 4), 40 hemodialysis(HD) patients, and 12 peritoneal dialysis(PD) patients. Tumor necrosis factor-α(TNF-α), interleukin-1β(IL-1β), interleukin-6(IL-6) and C-reactive protein(CRP) were analyzed by immunosorbent assay kit(ELISA)(Cayman Chemical's ACETM EIA kit). Immunoassay methods were used for total homocysteine(tH cy)(fluorescence polarization immunoanalysis HPLC, Perkin Emer 200 series), transferrin(MININEPHTM human transferin kit: ZK070.R), ferritin(ADVIA Centaur) and fibrinogen analysis(ACL 200). Differences between groups were performed using SPSS 20.0 and data are expressed as the mean ± SD.RESULTS: Results showed that in comparison with CRF 1 group and other groups, TNF-α and IL-6 levels were respectively more elevated in HD(16.38 ± 5.52 pg/mL vs 0.39 ± 0.03 pg/mL, 11.05 ± 3.59 pg/mL vs 8.20 ± 0.22 pg/mL, P < 0.001) and PD(14.04 ± 3.40 pg/m L vs 0.39 ± 0.03 pg/m L, 10.15 ± 1.66 pg/m L vs 8.20 ± 0.22 pg/m L, P < 0.001). IL-1β levels were increased in HD(9.63 ± 3.50 pg/m L vs 3.24 ± 0.10 pg/mL, P < 0.001) and CRF 4(7.76 ± 0.66 pg/mL vs 3.24 ± 0.10 pg/m L, P < 0.001) patients than in CRF 1 and in the other groups. Plasma t Hcy levels were higher in HD(32.27 ± 12.08 μmol/L) and PD(28.37 ± 4.98 μmol/L) patients compared to the other groups of CRF(P < 0.001). The serum CRP level was significantly increased in HD(18.17 ± 6.38 mg/L) and PD(17.97 ± 4.85 mg/L) patients compared to the other groups of CRF patients(P < 0.001). The plasma fibrinogen level was more elevated in HD(6.86 ± 1.06 g/L) and CRF 4(6.05 ± 0.57 g/L) than in the other groups(P < 0.001). Furthermore; the ferritin level was higher in HD(169.90 ± 62.16 ng/m L) and PD(90.08 ± 22.09 ng/m L) patients compared to the other groups of CRF(P < 0.001). The serum transferrin value was significantly decreased especially in PD(1.78 ± 0.21 g/L) compared to the other groups(P < 0.001). We found a negative correlationbetween glomerular filtration rate(GFR), TNF-α levels(r =-0.75, P < 0.001), and t Hcy levels(r =-0.68, P < 0.001). We observed a positive correlation between GFR and transferrin levels(r = 0.60, P < 0.001). CONCLUSION: CRF was associated with elevated inflammatory markers. The inflammation was observed at the severe stage of CRF and increases with progression of renal failure.展开更多
In 2002,the National Kidney Foundation Kidney Disease Outcomes Quality Initiative(NKF KDOQI)instituted new guidelines that established a novel chronic kidney disease(CKD)staging paradigm.This set of guidelines,since u...In 2002,the National Kidney Foundation Kidney Disease Outcomes Quality Initiative(NKF KDOQI)instituted new guidelines that established a novel chronic kidney disease(CKD)staging paradigm.This set of guidelines,since updated,is now very widely accepted around the world.Nevertheless,the authoritative United States Preventative Task Force had in August 2012acknowledged that we know surprisingly little about whether screening adults with no signs or symptoms of CKD improve health outcomes and that we deserve better information on CKD.More recently,the American Society of Nephrology and the American College of Physicians,two very well respected United States professional physician organizations were strongly at odds coming out with exactly opposite recommendations regarding the need or otherwise for"CKD screening"among the asymptomatic population.In this review,we revisit the various angles and perspectives of these conflicting arguments,raise unanswered questionsregarding the validity and veracity of the NKF KDOQI CKD staging model,and raise even more questions about the soundness of its evidence-base.We show clinical evidence,from a Mayo Clinic Health System Renal Unit in Northwestern Wisconsin,United States,of the pitfalls of the current CKD staging model,show the inexactitude and unpredictable vagaries of current CKD prediction models and call for a more cautious and guarded application of CKD staging paradigms in clinical practice.The impacts of acute kidney injury on CKD initiation and CKD propagation and progression,the effects of such phenomenon as the syndrome of late onset renal failure from angiotensin blockade and the syndrome of rapid onset end stage renal disease on CKD initiation,CKD propagation and CKD progression to end stage renal disease all demand further study and analysis.Yet more research on CKD staging,CKD prognostication and CKD predictions are warranted.Finally and most importantly,cognizant of the very serious limitations and drawbacks of the NKF K/DOQI CKD staging model,the need to individualize CKD care,both in terms of patient care and prognostication,cannot be overemphasized.展开更多
文摘Kidney transplantation is the treatment of choice for endstage renal disease.The evaluation of graft function is mandatory in the management of renal transplant recipients.Glomerular filtration rate(GFR),is generally considered the best index of graft function and also a predictor of graft and patient survival.However GFR measurement using inulin clearance,the gold standard for its measurement and exogenous markers such as radiolabeled isotopes(51Cr EDTA,99 mTc DTPA or 125 I Iothalamate) and non-radioactive contrast agents(Iothalamate or Iohexol),is laborious as well as expensive,being rarely used in clinical practice.Therefore,endogenous markers,such as serum creatinine or cystatin C,are used to estimate kidney function,and equations using these markers adjusted to other variables,mainly demographic,are an attempt to improve accuracy in estimation of GFR(e GFR).Nevertheless,there is some concern about the inability of the available e GFR equations to accurately identify changes in GFR,in kidney transplant recipients.This article will review and discuss the performance and limitations of these endogenous markers and their equations as estimators of GFR in the kidney transplant recipients,and their ability in predicting significant clinical outcomes.
文摘目的:探讨机器人辅助下肾癌肾部分切除术(RAPN)后肾细胞癌(RCC)患者肾功能保留和达成三连胜结局的影响因素,为指导术前评估、术后治疗和远期随访提供依据。方法:回顾性分析行机器人辅助下肾部分切除术的111例RCC患者的临床资料,根据是否达成三连胜结局分为三连胜组(n=73)和非三连胜组(n=38),根据术前和术后24 h估计肾小球滤过率(eGFR)变化分为术后24 h eGFR下降≤10%组(n=85)和术后24 h eGFR下降>10%组(n=26)。分别比较2组患者年龄、性别、美国麻醉医师协会(ASA)评分、体质量指数(BMI)、高血压、糖尿病、术前eGFR、术后24 h eGFR变化百分率、肾门部肿瘤、肿瘤背腹侧位置、肿瘤最大径、手术路径、热缺血时间(WIT)、估计出血量(EBL)、肿瘤病理类型、肿瘤TNM分期、RENAL评分、PADUA评分、中心性指数(C-index)、肾脏肿瘤侵袭指数(RTII)和肿瘤接触面积(CSA)。多因素Logistic回归分析患者达成三连胜和术后24 h eGFR变化下降>10%的影响因素,多元线性回归分析影响患者术后24 h eGFR变化的影响因素。结果:111例患者中共73例患者达成三连胜结局。单因素分析,三连胜组和非三连胜组患者年龄、高血压、肿瘤最大径、RENAL评分、PADUA评分、C-index、RTII、CSA和EBL比较差异有统计学意义(P<0.05)。多因素Logistic分析,EBL是RAPN术后患者未达成三连胜结局的独立影响因素(OR=1.006,95%CI=1.001-1.011,P=0.020)。术后24heGFR下降>10%组和术后24 h eGFR下降≤10%组患者肿瘤最大径、RENAL评分、PADUA评分、C-index、RTII、CSA、WIT、EBL和肿瘤TNM分期比较差异有统计学意义(P<0.05)。多因素Logisitc回归分析,RTII是患者术后24 h eGFR下降>10%的独立影响因素(OR=4.442,95%CI=1.049-18.806,P=0.043)。肿瘤最大径、RENAL评分、PADUA评分、C-index、RTII、CSA、WIT、EBL、肿瘤TNM分期与术后eGFR变化无明显关联,RTII与术后24 h eGFR变化呈负相关关系(B=-7.204,95%CI=-14.305--0.102,P=0.047)。结论:EBL是RAPN术后患者未能达成三连胜结局的独立影响因素,RTII与RAPN术后24 h eGFR变化呈负相关关系。
文摘目的探讨单侧上尿路梗阻解除前后肾皮质厚度(RCT)与肾小球滤过率(GFR)的关系。方法选取2015年7月-2016年6月该院泌尿外科收治的63例上泌尿道梗阻患者为研究对象。其中,男34例,女29例,年龄22~73(52.21±11.56)岁;手术方式:输尿管镜碎石+取石术24例,一期经皮肾造瘘+二期经皮肾镜取石术(PCNL)21例,一期PCNL 18例。采用腹部增强CT、单光子发射计算机断层(SPECT)扫描分别测量RCT和GFR,根据术前患肾GFR情况分为3组:A组(中度肾损害,15.0 ml/min≤GFR<30.0 ml/min)、B组(重度肾损害,7.5 ml/min≤GFR<15.0 ml/min)、C组(极重度肾损害,GFR<7.5 ml/min),比较3组的手术前后的GFR变化。采用简单线性相关分析A和B组患者术前RCT与各指标的相关性。结果 9例患者因肾积水严重未测量RCT,患者的术前RCT>10 mm 20例,5~10 mm 23例,<5 mm 11例,平均值为(10.75±4.91)mm。A组术前RCT明显高于B组,差异有统计学意义(P<0.05)。3组患者术后1和9个月的GFR均明显高于同组术前,差异均有统计学意义(P<0.05)。A组术后1和9个月的GFR均明显高于另外两组,B组术后9个月的GFR明显高于C组,差异均有统计学意义(P<0.05),但术后1个月B组和C组的GFR差异无统计学意义(P>0.05)。B组术后1个月的GFR恢复值明显低于另外两组,差异有统计学意义(P<0.05),3组术后9个月的GFR恢复值比较差异无统计学意义(P>0.05)。术前RCT与术前GFR(r=0.613)、术后1个月GFR(r=0.697)及恢复值(r=0.552)、术后9个月GFR(r=0.589)及恢复值(r=0.488)均呈显著正相关,差异有统计学意义(P<0.05)。结论解除上泌尿道梗阻后患者的肾功能得到不同程度的恢复,即使是极重度肾功能损伤者,多数均能挽回患肾。术前RCT能有助于判断围手术期的肾功能,尤其是术后肾功能恢复情况。
文摘目的以同位素扫描肾图为金标准考察肾脏增强CT动脉期、静脉期和实质期图像分别用于测量肾功能的可行性,并初步比较其准确性。方法前瞻性纳入52例单侧肾脏病变患者行常规肾脏增强CT检查和99mTc-DTPA肾动态显像Gates法肾功能测量。分别根据肾脏增强CT动脉期、静脉期和实质期的图像计算病肾的体积和CT强化值的乘积(Products of Volume and Enhancement,VE),用来描述病变肾脏的肾功能。以Gates法所测病变肾脏的肾小球滤过率(Gates-GFR)为金标准,用Pearson相关分析来评估各个CT期相VE和Gates-GFR的相关性,并依据相关系数的大小初步判断其准确性。结果肾脏动脉期、静脉期和实质期体积和强化值乘积(A-VE、V-VE、P-VE)均与Gates-GFR有较好的相关性,相关系数r分别为0.793、0.848和0.927,P值均小于0.001。结论肾脏增强CT三期扫描所得VE都和Gates-GFR呈正相关,均有可能用来评估肾功能,实质期可能更为准确。
文摘AIM: To evaluate determinants of inflammatory markers in chronic renal failure patients according to the level of glomerular filtration rate. METHODS: One hundred fifty four patients(Age; 44 ± 06 years, male/female; 66/88) with chronic renal failure(CRF) were divided into 6 groups according to the National Kidney Foundation(NKF) classification. They included 28 primary stage renal failure patients(CRF 1), 28 moderate stage renal failure patients(CRF 2),28 severe stage renal failure patients(CRF 3), 18 endstage renal failure patients(CRF 4), 40 hemodialysis(HD) patients, and 12 peritoneal dialysis(PD) patients. Tumor necrosis factor-α(TNF-α), interleukin-1β(IL-1β), interleukin-6(IL-6) and C-reactive protein(CRP) were analyzed by immunosorbent assay kit(ELISA)(Cayman Chemical's ACETM EIA kit). Immunoassay methods were used for total homocysteine(tH cy)(fluorescence polarization immunoanalysis HPLC, Perkin Emer 200 series), transferrin(MININEPHTM human transferin kit: ZK070.R), ferritin(ADVIA Centaur) and fibrinogen analysis(ACL 200). Differences between groups were performed using SPSS 20.0 and data are expressed as the mean ± SD.RESULTS: Results showed that in comparison with CRF 1 group and other groups, TNF-α and IL-6 levels were respectively more elevated in HD(16.38 ± 5.52 pg/mL vs 0.39 ± 0.03 pg/mL, 11.05 ± 3.59 pg/mL vs 8.20 ± 0.22 pg/mL, P < 0.001) and PD(14.04 ± 3.40 pg/m L vs 0.39 ± 0.03 pg/m L, 10.15 ± 1.66 pg/m L vs 8.20 ± 0.22 pg/m L, P < 0.001). IL-1β levels were increased in HD(9.63 ± 3.50 pg/m L vs 3.24 ± 0.10 pg/mL, P < 0.001) and CRF 4(7.76 ± 0.66 pg/mL vs 3.24 ± 0.10 pg/m L, P < 0.001) patients than in CRF 1 and in the other groups. Plasma t Hcy levels were higher in HD(32.27 ± 12.08 μmol/L) and PD(28.37 ± 4.98 μmol/L) patients compared to the other groups of CRF(P < 0.001). The serum CRP level was significantly increased in HD(18.17 ± 6.38 mg/L) and PD(17.97 ± 4.85 mg/L) patients compared to the other groups of CRF patients(P < 0.001). The plasma fibrinogen level was more elevated in HD(6.86 ± 1.06 g/L) and CRF 4(6.05 ± 0.57 g/L) than in the other groups(P < 0.001). Furthermore; the ferritin level was higher in HD(169.90 ± 62.16 ng/m L) and PD(90.08 ± 22.09 ng/m L) patients compared to the other groups of CRF(P < 0.001). The serum transferrin value was significantly decreased especially in PD(1.78 ± 0.21 g/L) compared to the other groups(P < 0.001). We found a negative correlationbetween glomerular filtration rate(GFR), TNF-α levels(r =-0.75, P < 0.001), and t Hcy levels(r =-0.68, P < 0.001). We observed a positive correlation between GFR and transferrin levels(r = 0.60, P < 0.001). CONCLUSION: CRF was associated with elevated inflammatory markers. The inflammation was observed at the severe stage of CRF and increases with progression of renal failure.
文摘In 2002,the National Kidney Foundation Kidney Disease Outcomes Quality Initiative(NKF KDOQI)instituted new guidelines that established a novel chronic kidney disease(CKD)staging paradigm.This set of guidelines,since updated,is now very widely accepted around the world.Nevertheless,the authoritative United States Preventative Task Force had in August 2012acknowledged that we know surprisingly little about whether screening adults with no signs or symptoms of CKD improve health outcomes and that we deserve better information on CKD.More recently,the American Society of Nephrology and the American College of Physicians,two very well respected United States professional physician organizations were strongly at odds coming out with exactly opposite recommendations regarding the need or otherwise for"CKD screening"among the asymptomatic population.In this review,we revisit the various angles and perspectives of these conflicting arguments,raise unanswered questionsregarding the validity and veracity of the NKF KDOQI CKD staging model,and raise even more questions about the soundness of its evidence-base.We show clinical evidence,from a Mayo Clinic Health System Renal Unit in Northwestern Wisconsin,United States,of the pitfalls of the current CKD staging model,show the inexactitude and unpredictable vagaries of current CKD prediction models and call for a more cautious and guarded application of CKD staging paradigms in clinical practice.The impacts of acute kidney injury on CKD initiation and CKD propagation and progression,the effects of such phenomenon as the syndrome of late onset renal failure from angiotensin blockade and the syndrome of rapid onset end stage renal disease on CKD initiation,CKD propagation and CKD progression to end stage renal disease all demand further study and analysis.Yet more research on CKD staging,CKD prognostication and CKD predictions are warranted.Finally and most importantly,cognizant of the very serious limitations and drawbacks of the NKF K/DOQI CKD staging model,the need to individualize CKD care,both in terms of patient care and prognostication,cannot be overemphasized.
