Nomenclature for kidney function and disease: Executive summary and glossary from a Kidney Disease: Improving Global Outcomes (KDIGO) Consensus Conference

A primary obligation of medical journals is the responsible, professional, and expeditious delivery of knowledge from researchers and practitioners to the wider community. The task of journal editors, therefore, rests not merely in selecting what to publish, but in large measure judging how it can best be communicated. The challenge of improving descriptions of kidney function and disease in medical publishing was the impetus for a Kidney Disease: Improving Global Outcomes (KDIGO) Consensus Conference held in June 2019. The conference goals included standardizing and refining kidney-related nomenclature used in English-language scientific articles and developing a glossary that can be used by journals. The rationale for the conference was that the worldwide burden of kidney disease is rising, but public awareness remains limited, underscoring the need for effective communication by stakeholders in the kidney health community. Despite this need, the nomenclature for describing kidney function and disease lacks uniformity and clarity. Two decades ago, a survey of hundreds of published articles and meeting abstracts reported a broad array of overlapping, confusing terms for chronic kidney disease (CKD) and advocated adoption of unambiguous terminology. Nevertheless, terms flagged by that analysis as problematic, such as “chronic renal failure” and “pre-dialysis,” still appear in current-day publications. A coherent, shared nomenclature could improve communication at all levels, to not only foster better appreciation of the burden of disease but also aid understanding of how patients feel about their disease, allow more effective communication between kidney disease specialists and other clinicians, advance more straightforward comparison and integration of datasets, enable better recognition of gaps in knowledge for future research, and facilitate more comprehensive public health policies for acute and chronic kidney disease. Developing consistent, patient-centered, and precise descriptions of kidney function and disease in the scientific literature is an important objective to align communication in clinical practice, research, and public health. Although some terms have been in use for decades, the increased exchange of information among stakeholders makes it timely to revisit nomenclature in order to ensure consistency. The goal is to facilitate communication within and across disciplines and between practitioners and patients, with the ultimate hope of improving outcomes through consistency and precision. Attendees at the conference included editors of kidney subspecialty journals, kidney subspecialty editors at general medical journals and journals from other subspecialties, experienced authors of clinical kidney health research, and patients. Guiding principles of the conference were that the revised nomenclature should be patient-centered, precise, and consistent with nomenclature used in the KDIGO guidelines. The discussion focused on general description of acute and chronic kidney disease and kidney measures, rather than specific kidney diseases and particular measures of function and structure. Classifications of causes of kidney disease and procedures, performance measures, and outcome metrics for dialysis and transplantation were considered beyond the scope of discussion. As described in detail in the conference report, the meeting attendees reached general consensus on the following recommendations: (a) to use “kidney” rather than “renal” or “nephro-” when referring to kidney disease and kidney function; (b) to use “kidney failure” with appropriate descriptions of presence or absence of symptoms, signs, and treatment rather than “end-stage kidney disease”; (c) to use the KDIGO definition and classification of acute kidney diseases and disorders (AKD) and acute kidney injury (AKI) rather than alternative descriptions to define and classify the severity of these; (d) to use the KDIGO definition and classification of CKD rather than alternative descriptions to define and classify it; and (e) to use specific kidney measures, such as albuminuria or decreased glomerular filtration rate, rather than “abnormal” or “reduced” kidney function to describe alterations in kidney structure and function (Table 1). Accordingly, the proposed glossary contains 5 corresponding sections, and comprises specific items for which there was general agreement among the conference participants (https://kdigo.org/conferences/nomenclature/; Table 2). For each section, the glossary includes preferred terms, abbreviations, descriptions, and terms to avoid, with the This article is being published in Kidney International Reports and reprinted concurrently in AJKD, AJN, CRM, CKJ, CEN, CN, CONH, DRCP, JORC, JN, JON, JRN, KD, KM, KRCP, NDT, PN, PDI, RN, SN, Transplantation, and TRI. The articles cover identical concepts and wording but vary in minor stylistic and spelling changes, detail, and length of manuscript, in keeping with each journal's style. Any of these versions may be used in citing this article. Excerpts are adapted with permission of KDIGO and the International Society of Nephrology. Received: 2 June 2020 Accepted: 6 June 2020