geoffrey modest medical blogs

  A new meta-analysis confirmed the rather common finding of significant discordance between estimated GFR (eGFR) by cystatin vs creatinine, finding that when eGFR was significantly lower by cystatin, there were significant increases in all-cause mortality, cardiovascular events, and kidney failure (see  ckd cystatin better than creat JAMA2025  in dropbox, or doi:10.1001/jama.2025.17578)   Details : -- the data source for this meta-analysis was the Participants in the Chronic Kidney Disease Prognosis Consortium (CKD-PC), focusing on participants with concurrent Cystatin-C (referred to as cystatin below) and creatinine measurements (eGFRcys and eGFRcr, respectively) and clinical outcomes, using an individual-level meta-analysis -- 23 outpatient cohorts: total of 821327 individuals     -- mean age 59, 48% female, 13.5% with diabetes, 40% with hypertension     -- mean eGFRcr 87, mean eGFRcys 81, median eGFRcys-eGFRcr difference of -5.4%, me...

  A new clinical guideline by the Kidney Disease: Improving Global Outcomes (KDIGO) on the evaluation and management of chronic kidney disease: see   ckd kdigo guidelines AnnIntMed2025  in dropbox, or doi:10.7326/ANNALS-24-01926   Overview : -- these guidelines pertain to all patients with chronic kidney disease (CKD) who are not on kidney replacement therapy (KRT), with the current synopsis referring to their highest recommendations and some upgraded practice points that have evolved since 2012 (these practice points are based on expert opinion) -- the guidelines emphasize a tailored-care approach, which does vary over the life course from infants to old age -- they note that these guidelines will only be feasible in higher-resource settings, despite being from a "global" organization   Recommendations : -- staging CKD:     -- they encourage routine testing for patients at risk, including those with hypertension, diabetes, multisystem d...