Changing the Face of Kidney Patient Care

National Kidney Foundation celebrates 20 years of developing the first comprehensive clinical practice guidelines for kidney disease
New York, NY—November 1, 2017—Twenty years ago, the National Kidney Foundation (NKF) set out to change the standards for treating and caring for dialysis patients and all people affected by chronic kidney disease (CKD). By developing the first comprehensive clinical practice guidelines for kidney disease, known as the Kidney Disease Outcomes Quality Initiative (KDOQI), NKF created a new classification system and an approach to care used today throughout the world, and in doing so, helped revolutionize the care of patients with kidney disease. View a video about KDOQI.
“Since the introduction of the NKF-KDOQI Guidelines, the mortality rate among end stage renal disease patients in the U.S. has dropped by over 30%, and the mortality rate for dialysis patients declined by over 26%,” said Kerry Willis, PhD, Chief Scientific Officer, NKF. “The KDOQI guidelines have had a significant impact on clinical practice, research and public health worldwide and have led to a better understanding of the prevalence of chronic kidney disease and the best practices for treatment.”
In 1997, NKF published the first evidence-based clinical practice guidelines in nephrology under the Dialysis Outcomes Quality Initiative (DOQI) banner. Recognizing the need to treat kidney disease earlier to improve outcomes, not just for dialysis patients, but for all patients with kidney disease, DOQI was soon expanded to the Kidney Disease Outcomes Quality Initiative (KDOQI).  Now 20 years later, NKF has published 18 sets of KDOQI guidelines addressing early identification, staging/classification, prevention and management of kidney disease and related conditions, as well as recommendations for the optimization of renal replacement therapy.
“NKF played the leading role in the movement to develop clinical practice guidelines for kidney disease. During the twenty years since then, we have witnessed a revolution in our approach to kidney disease,” said Andrew Levey, MD; Dr. Gerald J. and Dorothy R. Professor of Medicine Emeritus, Tufts University School of Medicine, Boston, MA. “We now use definitions and classification systems that are based on objective findings; we have improved outcomes in patients treated by dialysis; our estimate of the burden of earlier stages of disease is based on more robust epidemiology; we now recognize chronic kidney disease and acute kidney injury as a global public health problem and a risk factor for other diseases; and we have made great strides in public awareness.  There is much, much more to do to improve outcomes, but we are now on solid footing. I am proud to have been associated with NKF in these efforts.” Dr. Levey served as Workgroup Chair for the 2002 KDOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification and Stratification. 
In addition to the 30% and 26% percent reduction in mortality among end stage renal disease and dialysis patients respectively, the impact of the NKF-KDOQI Guidelines has been widespread. The 2002 Chronic Kidney Disease Guidelines, published under the KDOQI umbrella, provided the first uniform definition and staging system for kidney disease based on its severity. This allowed for a common language for communication among providers, patients and their families, researchers and policy-makers and created a framework for developing a public health approach to affect care and improve outcomes of CKD. This guideline also endorsed a creatinine-based estimated glomerular filtration rate (eGFR) as a readily available, low cost method for detection and classification of kidney disease.  eGFR is now used globally as the standard clinical measurement to assess kidney function and diagnose CKD.
The Vascular Access Guidelines highlighted the advantages of early placement of an arteriovenous fistula to reduce the complications and increased mortality associated with tunneled hemodialysis catheters. This guideline has benefited patients by inspiring quality improvement initiatives nationwide to reduce hemodialysis vascular access clotting problems and blood stream infections.
The KDOQI-CKD Classification System is used as the benchmark to define goals to improve outcomes across all stages of CKD, including by the U.S. Office of Disease Prevention and Health Promotion, which establishes goals to improve the health of the nation through its Healthy People initiative.
“The impact of the KDOQI guidelines on patient health cannot be overstated,” said Michael Rocco, MD, MSCE, FNKF, Vardaman M. Buckalew Jr. Professor in Internal Medicine/Nephrology at Wake Forest School of Medicine, Winston-Salem, NC, and National Kidney Foundation KDOQI Chair.  “Before the KDOQI guidelines were developed there was no clear cut, standardized pathway for treating patients or for pursuing research opportunities to improve outcomes in patients with chronic kidney disease. The KDOQI guidelines were the first of many national guidelines, as well as an international set of guidelines, that are focused on best practices for patients with chronic kidney disease.”
KQODI’s Next Chapter
Two Guideline Updates will be published in 2018; Clinical Practice Guideline for Vascular Access; and Clinical Practice Guideline for Nutrition in CKD. In addition, NKF will convene the KDOQI Home Dialysis Controversies Conference in November 2017 which includes a multi-stakeholder group of patients, clinicians, researchers, health payers, policy makers and representatives from dialysis equipment and provider companies.  The goals of this initiative are to facilitate the development of research designs that measure home dialysis quality and evaluate interventions to address barriers to maintaining dialysis treatment at home. The findings from this two-year project will inform the development of a cross-organizational collaboration on a home dialysis quality improvement initiative headed by KDOQI leadership. 
“With each update to the KDOQI Guidelines, nephrology professionals worldwide are presented with new treatment management algorithms designed to improve clinical practice as well as suggestions for further research where evidence is not yet sufficient to generate guideline statements. It has been a privilege for me to be a part of the KDOQI guideline development process,” added Dr. Rocco.  
View a fact sheet on the NKF-KDOQI Guidelines along with quotes detailing the impact to patients and professionals. Nephrology professionals are invited to share examples of how the KDOQI guidelines impacted their clinical practice by using the hashtag #KDOQIturns20.
Kidney Disease Facts
30 million American adults are estimated to have chronic kidney disease—and most aren’t aware of it.  1 in 3 American adults are at risk for chronic kidney disease.  Risk factors for kidney disease include diabetes, high blood pressure, heart disease, obesity and family history of kidney failure.  People of African American, Hispanic, Native American, Asian or Pacific Islander descent are at increased risk for developing the disease.  African Americans are 3 times more likely than Whites, and Hispanics are nearly 1.5 times more likely than non-Hispanics to develop end stage renal disease (kidney failure).

The National Kidney Foundation (NKF) is the largest, most comprehensive and longstanding organization dedicated to the awareness, prevention and treatment of kidney disease. For more information about NKF visit