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Extract: In 2002 the United States Kidney Foundation launched a novel framework for defining and classifying chronic kidney disease. The framework was widely embraced because it imposed order in a chaotic landscape characterised by a variety of names, including renal insufficiency, renal impairment, and renal failure. It has had an appreciable effect on clinical care worldwide through guidelines, pay for performance measures, and sparked debate on the merits of screening programmes. However, it has also generated considerable controversy. We examine the rationale for the framework, the varying responses and controversies it has provoked, and provide advice for clinicians who are being faced with an increasing number of people categorised as having chronic kidney disease.
This document has been peer reviewed.