European Heart Journal (2020) 00, 1–7 SPECIAL ARTICLE

doi:10.1093/eurheartj/ehaa650 Disease management

Nomenclature for kidney function and

disease—executive summary and glossary from

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a Kidney Disease: Improving Global Outcomes
(KDIGO) consensus conference
Andrew S. Levey 1*, Kai-Uwe Eckardt 2
*, Nijsje M. Dorman 3,
Stacy L. Christiansen4, Michael Cheung 5
, Michel Jadoul 6, and
Wolfgang C. Winkelmayer 7
1
Division of Nephrology, Tufts Medical Center, Box 391, 800 Washington Street, Boston, MA 02111, USA; 2Department of Nephrology and Medical Intensive Care,
Charité—Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin 13353, Germany; 3AJKD, Philadelphia, PA 19104, USA; 4JAMA, Chicago, IL 60654, USA; 5KDIGO, Avenue
Louise 65, Suite 11, Brussels 1050, Belgium; 6Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Avenue Hippocrate 10, Brussels 1200, Belgium; and 7Selzman
Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA

Received 30 March 2020; revised 5 May 2020; editorial decision 24 July 2020; accepted 1 September 2020

Abstract The worldwide burden of kidney disease is rising, but public awareness remains limited, underscoring the need for more
effective communication by stakeholders in the kidney health community. Despite this need for clarity, the nomenclature
for describing kidney function and disease lacks uniformity. In June 2019, Kidney Disease: Improving Global Outcomes
(KDIGO) convened a consensus conference with the goal of standardizing and refining the nomenclature used in the
English language to describe kidney function and disease, and of developing a glossary that could be used by journals in sci-
entific publications. Guiding principles of the conference were that the revised nomenclature should be patient-centred,
precise, and consistent with nomenclature used in the KDIGO guidelines. Conference attendees reached general consen-
sus on the following recommendations: (i) to use ‘kidney’ rather than ‘renal’ or ‘nephro’ when referring to kidney disease
and kidney function; (ii) to use ‘kidney failure’ with appropriate descriptions of the presence or absence of symptoms,
signs, and treatment rather than ‘end-stage’ kidney disease; (iii) to use the KDIGO definition and classification of acute kid-
ney diseases and disorders (AKD) and acute kidney injury (AKI) rather than alternative descriptions to define and classify
the severity of AKD and AKI; (iv) to use the KDIGO definition and classification of chronic kidney disease (CKD) rather
than alternative descriptions to define and classify the severity of CKD; and (v) to use specific kidney measures, such as al-
buminuria or decreased glomerular filtration rate, rather than ‘abnormal or reduced kidney function’ to describe altera-
tions in kidney structure and function. A proposed five-part glossary contains specific items for which there was general
agreement. Conference attendees acknowledged limitations of the recommendations and glossary but considered that
standardizing scientific nomenclature is essential for improving communication.

* Corresponding authors. Tel: 1-617-636-5898, Email: alevey@tuftsmedicalcenter.org (A.S.L.); Tel: þ49 30 4505 14002, Email: kai-uwe.eckardt@charite.de (K.-U.E.)
This editorial is published concurrently in multiple journals with minor differences and serves as an executive summary of the full report published in Kidney International.1
Excerpts are adapted with the permission of KDIGO and the International Society of Nephrology.
VC KDIGO 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/),
which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact
journals.permissions@oup.com
2 A.S. Levey et al.

Graphical Abstract

Why uniform nomenclature on kidney function and disease?

• Reduces confusion and errors in clinical practice

• Promotes consistency in research design,
execution, and communication
• Raises public awareness
• Facilitates communication between Persistent albuminuria categories
healthcare provider and patient Description and range

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• Takes into account patient preferences
and his/her needs and values A1 A2 A3
• Minimizes language ambiguity and mobilizes Prognosis of CKD by GFR and Normal to mildly Moderately Severely
self-management and advocacy albuminuria categories: KDIGO 2012 increased increased increased
< 30 mg/g 30–300 mg/g > 300 mg/g
Key take-home messages < 3 mg/mmol 3–30 mg/mmol > 30 mg/mmol

1 Use ‘kidney’ rather than ‘renal’ or ‘nephro-’ when referring to kidney disease G1 Normal or high ≥ 90
and kidney function

GFR categories (ml/min/1.73 m2)

2 Use ‘kidney failure’ with appropriate descriptions of presence or absence of
G2 Mildly decreased 60–89

Description and range

symptoms, signs, and treatment rather than ‘end‐stage kidney disease’
since latter term is not patient-sensitive and connotes stigma
Mildly to
G3a 45–59
3 Use the KDIGO definition and classification of acute kidney diseases and moderately decreased
disorders (AKD) and acute kidney injury (AKI) rather than alternative
descriptions to define and classify severity of AKD and AKI; AKI stages Moderately to
G3b severely decreased 30–44
(1, 2, 3) should be used to denote severity of AKI
4 Use the KDIGO definition and classification of CKD rather than alternative G4 Severely decreased 15–29
descriptions to define and classify CKD. Ascertainment of CKD when GFR
> 60 ml/min/1.73 m2 requires assessment for markers of kidney damage
(e.g., albuminuria). CKD should be classified according to cause and G5 Kidney failure < 15
categories of GFR and albuminuria (CGA); severity of CKD should
correspond to risk categories (i.e., KDIGO heatmap, right)
low risk (if no other markers of kidney disease, no CKD)
5 Use specific kidney measures such as albuminuria or decreased GFR to
describe alterations in kidney structure and function, respectively, rather moderately increased risk
than general descriptors such as ‘abnormal’ or ‘reduced’ kidney function. high risk
Do not equate albuminuria or proteinuria as ‘decreased kidney function’
since they are markers of kidney damage very high risk

...................................................................................................................................................................................................

Keywords Acute kidney diseases and disorders • Acute kidney injury • Chronic kidney disease • Kidney disease
• Kidney failure • Kidney function • Kidney measures • Nomenclature • Patient-centredness • Precision
medicine

A primary obligation of medical journals is the responsible, profes-

.. deaths due to kidney failure, and an additional 1.4 million deaths due
..
sional, and expeditious delivery of knowledge from researchers and .. to cardiovascular disease (4.6% of total mortality).14 An earlier report
..
practitioners to the wider community.2 The task of journal editors, .. concluded that, in 2013, ‘Compared with metabolic risk factors,
therefore, rests not merely in selecting what to publish, but in large .. reduced glomerular filtration rate (GFR) ranked below high systolic
..
measure judging how it might best be communicated. The challenge .. blood pressure, high body mass index, and high fasting plasma glu-
of improving the descriptions of kidney function and disease in medic- .. cose, and similarly with high total cholesterol’.15
..
al publishing was the impetus for a Kidney Disease: Improving Global .. The rationale for the 2019 KDIGO conference was that the world-
Outcomes (KDIGO) consensus conference held in June 2019. The .. wide burden of kidney disease is rising, but public awareness remains
..
conference goals included standardizing and refining kidney-related .. limited, underscoring the need for effective communication by all
nomenclature used in English language scientific articles and develop-
.. stakeholders in the kidney health community.14,16–18 Despite this
..
ing a glossary that could be used by journals.3 .. need, the nomenclature for describing kidney function and disease
While a glossary of kidney-related nomenclature is most applicable
.. lacks uniformity and clarity. Two decades ago, a survey of hundreds
..
to kidney subspecialty journals, the interdependency of the kidney .. of published articles and meeting abstracts reported a broad array of
..
with other organ systems makes this glossary broadly relevant. For .. overlapping, confusing terms for CKD and advocated adoption of un-
instance, accelerated atherosclerosis was quickly recognized as a .. ambiguous terminology.19 Nevertheless, terms flagged by that ana-
..
complication in patients with kidney failure treated by maintenance .. lysis as problematic, such as ‘chronic renal failure’ and ‘pre-dialysis’,
haemodialysis,4 and guidelines have called attention to kidney disease .. still appear in current-day publications. A coherent, shared nomen-
..
as an independent risk factor for cardiovascular disease for >20 .. clature could improve communication at all levels, including not only
years.5–13 The Global Burden of Disease Study estimated the world- .. to better appreciate the burden of disease but also to aid understand-
..
wide prevalence of chronic kidney disease (CKD) in 2017 to be .. ing about how patients feel about their disease, allow more effective
697.5 million people (9.1% of the population), with 1.2 million
.. communication between kidney disease specialists and other
Nomenclature for kidney function and disease: a KDIGO consensus report 3

..
.. recommendations for English language medical journals: (i) to use
.. ‘kidney’ rather than ‘renal’ or ‘nephro’ when referring to kidney dis-
Persistent albuminuria categories ..
Description and range .. ease and kidney function; (ii) to use ‘kidney failure’ with appropriate
A1 A2 A3 .. descriptions of presence or absence of symptoms, signs, and treat-
Prognosis of CKD by GFR ..
and albuminuria categories: Normal to mildly
increased
Moderately
increased
Severely
increased .. ment rather than ‘end-stage kidney disease’; (iii) to use the KDIGO
KDIGO 2012 .. definition and classification of acute kidney diseases and disorders
< 30 mg/g
< 3 mg/mmol
30–300 mg/g > 300 mg/g
3–30 mg/mmol > 30 mg/mmol ..
.. (AKD) and acute kidney injury (AKI) rather than alternative descrip-
G1 Normal or high ≥ 90 .. tions to define and classify the severity of AKD and AKI; (iv) to use

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..
GFR categories (ml/min/1.73 m2)

G2 Mildly decreased 60–89 .. the KDIGO definition and classification of CKD rather than alterna-
Description and range

.. tive descriptions to define and classify CKD (Figure 1, Take home fig-
G3a
Mildly to
45–59 ..
moderately decreased
.. ure); and (v) to use specific kidney measures, such as albuminuria or
G3b
Moderately to
30–44 .. decreased GFR, rather than ‘abnormal’ or ‘reduced’ kidney function
severely decreased
..
G4 Severely decreased 15–29 .. to describe alterations in kidney structure and function (Table 1).
.. Accordingly, the proposed glossary contains five corresponding sec-
G5 Kidney failure < 15 ..
.. tions and comprises specific items for which there was general agree-
.. ment among the conference participants (https://kdigo.org/
Figure 1 Chronic kidney disease nomenclature used by Kidney ..
Disease: Improving Global Outcomes. Chronic kidney disease is .. conferences/nomenclature/, Supplementary material online, Table
.. S1).1 For each section, the glossary includes preferred terms, abbrevi-
defined as abnormalities of kidney structure or function, present for ..
>3 months, with implications for health. Chronic kidney disease is .. ations, descriptions, and terms to avoid, with the acknowledgment
classified based on cause, glomerular filtration rate category (G1–
.. that journals may choose which of the recommendations to imple-
..
G5), and albuminuria category (A1–A3), abbreviated as CGA. .. ment, and that journal style will dictate when and how to abbreviate
Prognosis of chronic kidney disease by glomerular filtration rate and ..
.. terms to be consistent with nomenclature for other diseases.
albuminuria category is colour-coded as follows: green, low risk (if .. A guiding principle for the development of the glossary was
no other markers of kidney disease, no chronic kidney disease); yel- ..
low, moderately increased risk; orange, high risk; red, very high risk.
.. patient-centredness. The Health and Medicine Division of US
.. National Academies of Sciences defines patient-centred care as
CKD, chronic kidney disease; GFR, glomerular filtration rate; ..
KDIGO, Kidney Disease: Improving Global Outcomes. .. ‘[p]roviding care that is respectful of, and responsive to, individual pa-
.. tient preferences, needs and values, and ensuring that patient values
..
.. guide all clinical decisions’.20 One of the 10 general principles recom-
.. mended for redesign of the health system is that ‘Knowledge is
..
clinicians, advance more straightforward comparison and integration .. shared and information flows freely. Patients should have unfettered
.. access to their own medical information and to clinical knowledge.
of datasets, enable better recognition of gaps in knowledge for future ..
research, and facilitate more comprehensive public health policies for
.. Clinicians and patients should communicate effectively and share in-
.. formation’. In principle, the terms used to describe kidney function
acute and CKDs. ..
Developing consistent, patient-centred, and precise descriptions
.. and disease should be understandable to all, with acknowledgment of
.. variation in the level of health literacy. Use of multiple terms with
of kidney function and disease in the scientific literature is an import- ..
.. similar meaning can lead to confusion, as can use of terms that fore-
ant objective to align communication in clinical practice, research, .. cast the future (such as ‘pre-dialysis’), rather than describe the pre-
and public health. While some terms have been in use for decades, ..
.. sent. However, convergence of multiple names into an accepted set
the increased exchange of information among stakeholders makes it .. of terms does require that users of the glossary are willing to accept
timely to revisit nomenclature to ensure consistency. The goal is to ..
.. that labels that have been pre-eminent historically, and that may be
facilitate communication within and across disciplines and between .. more familiar or memorable even now, should now be superseded.21
practitioners and patients, with the ultimate hope of improving out-
..
.. Of equal importance to patient-centredness in the development
comes through consistency and precision. ..
.. of the glossary was precision, which can generally be defined as exact-
Attendees at the conference included editors of many kidney sub- .. ness or accuracy.21 How medicine is defined and understood is
specialty journals, kidney subspecialty editors at high-impact general ..
.. changing rapidly from a descriptive disease-based categorization in
medical journals and a few journals from other subspecialties, experi- .. which multiple pathogenetic pathways may be conflated to
enced authors of clinical kidney health research, and patients. Guiding ..
.. mechanism-based categorization that will promote more precise
principles of the conference were that the revised nomenclature .. management of clinical problems. The latter approach, in which a mo-
should be patient-centred, precise, and consistent with nomenclature
..
.. lecular profile is added to the clinical and morphologic profile, has al-
used in the KDIGO guidelines. The discussion focused on the general .. ready revolutionized diagnosis and treatment in oncology. In
..
description of acute and CKD and kidney measures, rather than spe- .. nephrology, the ongoing Kidney Precision Medicine Project, funded
cific kidney diseases and particular measures of function and struc- .. by the National Institutes of Health, seeks to ethically obtain and
..
ture. Classifications of causes of kidney disease and procedures, .. evaluate kidney biopsies from participants with AKI or CKD; create a
performance measures, and outcomes metrics for dialysis and trans- .. kidney tissue atlas; define disease subgroups; and identify cells, path-
..
plantation were considered beyond the scope of discussion. .. ways, and targets for novel therapies.22 As has occurred in oncology,
As described in detail in the conference report,1 the meeting .. it is anticipated that refinements that result in more precise disease
..
attendees reached general consensus on the following . descriptions will be incorporated into current nomenclature for
4 A.S. Levey et al.

Table 1 Key takeaways from the conference

• Use the term ‘kidney’ rather than ‘renal’ to describe kidney function and kidney disease. In English the terms renal and kidney are still used interchange-
ably, resulting in different acronyms describing the same condition or status (e.g. ESRD/ESKD and RRT/KRT). It is more likely that patients and the public
would understand the terms incorporating the more familiar noun ‘kidney’, rather than the less familiar adjective ‘renal’, which is derived from Latin and
is labelled as technical in some dictionaries. Although writing guides may generally favour an appropriate adjective over a noun as a modifier, there are
high-profile precedents for the use of ‘kidney’ as a modifier, such as AKI, CKD, and NIDDK (National Institute of Diabetes and Digestive and Kidney

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Diseases)
• Avoid the term ‘end-stage’. Although rooted in US law, the term is not patient sensitive, may connote a stigma, and may discourage advocacy. In the
USA, ESRD (or ESKD) is a synonym for receipt of KRT. However, KRT is a treatment rather than a disease. The term ‘kidney failure’, which is defined as
GFR <15 mL/min/1.73 m2 or treatment by dialysis, is as comprehensive as ‘ESRD/ESKD’, without suffering from its limitations
• Improve characterization of the full spectrum of kidney failure. Although all patients with kidney failure have GFR <15 mL/min/1.73 m2 or are undergoing
treatment by dialysis, the severity of symptoms varies greatly. We lack terms to describe the severity of symptoms and signs, and yet they are indications
for initiating KRT. There are also no common patient-reported outcome measures to describe severity. The term ‘kidney failure’ in a chronic setting is
defined as >3 months, whereas in an acute setting (i.e. AKI Stage 3), it is reserved for a duration <_3 months. Kidney failure could be further classified
according to patient-reported outcomes (symptoms)
• Use more-descriptive terms for treatments for kidney failure. Many patients with kidney failure do not undergo KRT. The terms ‘treated’ vs. ‘untreated’
have been used, but this is not consistent with the idea that supportive care is indeed treatment. Furthermore, in some cases, patients choose supportive
care rather than KRT; in other cases, they do not have a choice because of lack of insurance or lack of availability. Finally, some patients may not be under
the care of a physician at all
• Avoid the use of ‘CKD’ as a synonym for ‘GFR <60 mL/min/1.73 m2’. CKD includes markers of kidney damage or GFR <60 mL/min/1.73 m2 for >3
months, so ascertainment of GFR without assessment for markers of kidney damage is insufficient for classification of CKD status when GFR >60 mL/
min/1.73 m2. If chronicity is not documented, it can be inferred on the basis of corroborative clinical data or presumed in the absence of clinical data to
the contrary
• Avoid the use of using ‘AKI’ as a synonym for ‘AKD’. AKD refers to kidney diseases and disorders with duration of <_3 months, whereas AKI refers to kid-
ney diseases and disorders with onset within 1 week
• Use ‘CKD GFR and albuminuria categories’ and ‘AKI stages’ to describe disease severity rather than employing ill-defined terms such as ‘mild’, ‘moderate’,
‘severe’, and ‘advanced’
• Use the terms ‘GFR categories’ and ‘albuminuria categories’ rather than ‘CKD stages’ when describing the level of GFR and albuminuria in populations
without CKD or without ascertainment of both GFR and albuminuria
• Use the term ‘risk categories’ to describe combinations of G (GFR) and A (albuminuria) categories from the KDIGO heat map (Figure 1)
• Use specific terms, such as ‘GFR’, ‘tubular secretion’, ‘tubular reabsorption’, ‘albuminuria’, and ‘proteinuria’, rather than general terms, such as ‘abnormal’
or ‘reduced’ kidney function, damage or injury, when possible. Because kidney function comprises several functional categories, including excretory,
endocrine, and metabolic functions, it should be described as specifically as possible. GFR is closely linked with the excretory function but should not be
used as a synonym, because tubular reabsorption and excretion also contribute to excretory function
• When referring to ‘decreased or decreasing GFR’, avoid the use of different, poorly defined terms such as: ‘impaired kidney function’, ‘renal insufficiency’,
‘renal dysfunction’, ‘renal impairment’, ‘worsening kidney function’, and ‘kidney function decline’
• When referring to GFR, use descriptive abbreviations (mGFR for measured GFR and eGFR for estimated GFR), with specific notation based on the en-
dogenous filtration markers used (e.g. eGFRcr, eGFRcys, and eGFRcr-cys). Additional detail can be given in the methods. For mGFR, the methods should
describe the exogenous filtration marker (e.g. inulin, iothalamate, iohexol) and clearance method (urinary clearance, plasma clearance). For eGFR, the
methods should describe the estimating equation used (CKD-EPI; MDRD study)
• Avoid referring to ‘albuminuria’ or ‘proteinuria’ as ‘decreased kidney function’. Albuminuria and proteinuria are markers of kidney damage, rather than
measures of kidney function
• When referring to albuminuria or proteinuria, avoid the terms ‘microalbuminuria’ and ‘macroalbuminuria/clinical proteinuria’. Use the terms ‘moderately
increased’ or ‘severely increased’ instead
• When referring to albuminuria and proteinuria, use descriptive abbreviations, such as ‘urine albumin or protein excretion rates (AER and PER)’ and ‘urine
albumin-creatinine or protein-creatinine ratios (ACR and PCR)’

ACR, albumin-creatinine ratio; AER, albumin excretion rate; AKD, acute kidney diseases and disorders; AKI, acute kidney injury; CKD, chronic kidney disease; CKD-EPI, CKD
Epidemiology Collaboration; eGFR, estimated glomerular filtration rate; eGFRcr, estimated glomerular filtration rate derived from creatinine; eGFRcr-cys, estimated glomerular fil-
tration rate derived from creatinine and cystatin C; eGFRcys, estimated glomerular filtration rate derived from cystatin C; ESKD, end-stage kidney disease; ESRD, end-stage renal
disease; GFR, glomerular filtration rate; KDIGO, Kidney Disease: Improving Global Outcomes; KRT, kidney replacement therapy; MDRD, Modification of Diet in Renal Disease;
mGFR, measured glomerular filtration rate; NIDDK, National Institute of Diabetes and Digestive and Kidney Diseases; PCR, protein-creatinine ratio; PER, protein excretion rate;
RRT, renal replacement therapy; US, United States.
Nomenclature for kidney function and disease: a KDIGO consensus report 5

Why uniform nomenclature on kidney function and disease?

• Reduces confusion and errors in clinical practice

• Promotes consistency in research design,
execution, and communication
• Raises public awareness
• Facilitates communication between Persistent albuminuria categories
healthcare provider and patient Description and range
• Takes into account patient preferences
and his/her needs and values A1 A2 A3

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• Minimizes language ambiguity and mobilizes Prognosis of CKD by GFR and Normal to mildly Moderately Severely
self-management and advocacy albuminuria categories: KDIGO 2012 increased increased increased
< 30 mg/g 30–300 mg/g > 300 mg/g
Key take-home messages < 3 mg/mmol 3–30 mg/mmol > 30 mg/mmol

1 Use ‘kidney’ rather than ‘renal’ or ‘nephro-’ when referring to kidney disease G1 Normal or high ≥ 90
and kidney function

GFR categories (ml/min/1.73 m2)

2 Use ‘kidney failure’ with appropriate descriptions of presence or absence of
G2 Mildly decreased 60–89

Description and range

symptoms, signs, and treatment rather than ‘end‐stage kidney disease’
since latter term is not patient-sensitive and connotes stigma
Mildly to
G3a 45–59
3 Use the KDIGO definition and classification of acute kidney diseases and moderately decreased
disorders (AKD) and acute kidney injury (AKI) rather than alternative
descriptions to define and classify severity of AKD and AKI; AKI stages Moderately to
G3b severely decreased 30–44
(1, 2, 3) should be used to denote severity of AKI
4 Use the KDIGO definition and classification of CKD rather than alternative G4 Severely decreased 15–29
descriptions to define and classify CKD. Ascertainment of CKD when GFR
> 60 ml/min/1.73 m2 requires assessment for markers of kidney damage
(e.g., albuminuria). CKD should be classified according to cause and G5 Kidney failure < 15
categories of GFR and albuminuria (CGA); severity of CKD should
correspond to risk categories (i.e., KDIGO heatmap, right)
low risk (if no other markers of kidney disease, no CKD)
5 Use specific kidney measures such as albuminuria or decreased GFR to
describe alterations in kidney structure and function, respectively, rather moderately increased risk
than general descriptors such as ‘abnormal’ or ‘reduced’ kidney function. high risk
Do not equate albuminuria or proteinuria as ‘decreased kidney function’
since they are markers of kidney damage very high risk

Take home figure Objectives and conclusions of the KDIGO consensus conference on nomenclature for kidney function and disease.

..
kidney function and disease, rather than replace it altogether. Thus, .. implementation of a revised nomenclature. The glossary will be freely
although the glossary is designed to be consistent with current know- .. available on the KDIGO website (https://kdigo.org/conferences/no
..
ledge and stable enough to remain relevant for the foreseeable fu- .. menclature/) and Supplementary material online, Table S1. Elements
ture, it is also intended to be sufficiently flexible to accommodate
.. of the glossary will be included in online updates to the newly
..
new vocabulary arising with advances in the field. .. released (11th) edition of the AMA Manual of Style.23 Medical journals
A central strength of the proposed glossary is that it is based on
.. adopting the recommendations will need to determine how to imple-
..
existing KDIGO definitions, classifications, and nomenclature for .. ment them and this process will require education of editorial staff as
..
acute and CKD. In addition, it was developed using a systematic pro- .. well as proactive communication with authors, generally and with re-
cess, including articulation of a clear and transparent rationale (pa- .. gard to specific manuscripts. Translations to languages other than
..
tient-centredness and precision); capture of stakeholder viewpoints .. English will be necessary for the selection of preferred terms. If suc-
via patient focus groups and a corresponding survey; a period of pub- .. cessful, further implementation in clinical practice, research, and pub-
..
lic comment on conference scope; and attainment of consensus .. lic health will require more widespread dissemination and
among attendees at the conference. While the recommendations are
.. professional education and integration into electronic health records.
..
not likely to answer all concerns, the consensus among conference .. Introduction of new terms will require revisions to definitions of
..
attendees was that standardizing scientific nomenclature is a neces- .. exposures, outcomes, and adjustment variables in research studies
sary first step to improving communications among clinicians, .. and to revisions to search strategies of bibliographic medical data-
..
researchers, and public health officials, and with patients, their families .. bases. Improving communication with patients and the public will re-
and caregivers, and the public. .. quire efforts to improve patient education and health literacy for the
..
Limitations of the proposed glossary are that it is restricted to .. public and guides to communication with patients that provide ap-
English (nuances may be difficult to translate); only a limited number
.. propriate translation to people with varying health literacy.
..
of stakeholders could participate due to practical reasons; it is not .. Professional societies, industry, and patient advocacy organizations
..
comprehensive (it does not include disease classification, dialysis, .. will be critical to these efforts.
transplantation); and further specification will be required for studies .. Advances in research, particularly in precision medicine, will
..
in children. For these and other reasons, we consider the current rec- .. introduce a myriad of new terms and novel concepts requiring in-
ommendations for a glossary as an important starting point, and it .. corporation into disease definitions and classifications. In addition,
..
will require future expansion and updating. .. the increasing prominence and participation of patient and care-
Achieving consensus among conference attendees and publication .. giver communities in defining research objectives and best practi-
..
of the conference report and glossary is only the first step in . ces in clinical care objectives will further elucidate the
6 A.S. Levey et al.

..
characteristics of patient-centred terminology. Expanding and .. Guidelines for the management of dyslipidaemias: lipid modification to reduce
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..
.. Mailloux LU, Manske CL, Meyer KB, Parfrey PS, Pfeffer MA, Wenger NK, Wilson
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.. 8. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V,
Acknowledgements .. Gonzalez-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C,
..
The authors are grateful to Juhi Chaudhari, MPH, at Tufts Medical .. Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM,
Center, Boston, MA, USA, for assistance with manuscript prepar- .. Ruschitzka F, Rutten FH, van der Meer P2. ESC Guidelines for the diagnosis and
.. treatment of acute and chronic heart failure: the Task Force for the diagnosis
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supported by unrestricted educational grants from AstraZeneca,
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Roche, and Sanofi. The content of this article does not necessarily re-
..
.. Diener H-C, Heidbuchel H, Hendriks J, Hindricks G, Manolis AS, Oldgren J,
flect the views or opinions of the organizations or journals that were .. Popescu BA, Schotten U, Van Putte B, Vardas P, Agewall S, Camm J, Baron
.. Esquivias G, Budts W, Carerj S, Casselman F, Coca A, De Caterina R, Deftereos
represented at the conference. Responsibility for the information and .. S, Dobrev D, Ferro JM, Filippatos G, Fitzsimons D, Gorenek B, Guenoun M,
views expressed is limited to the co-authors. .. Hohnloser SH, Kolh P, Lip GYH, Manolis A, McMurray J, Ponikowski P,
.. Rosenhek R, Ruschitzka F, Savelieva I, Sharma S, Suwalski P, Tamargo JL, Taylor
Conflict of interest: A.S.L. declared having received research sup-
.. CJ, Van Gelder IC, Voors AA, Windecker S, Zamorano JL, Zeppenfeld K. ESC
..
port from AstraZeneca, National Institute of Diabetes and Digestive .. Guidelines for the management of atrial fibrillation developed in collaboration
.. with EACTS. Eur Heart J 2016;37:2893–2962.
and Kidney Diseases, and National Kidney Foundation. K.-U.E. .. 10. Neumann F-J, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U,
declared having received consultancy fees from Akebia, Bayer, and .. Byrne RA, Collet J-P, Falk V, Head SJ, Jüni P, Kastrati A, Koller A, Kristensen SD,
.. Niebauer J, Richter DJ, Seferovic PM, Sibbing D, Stefanini GG, Windecker S,
Genzyme; speaker honoraria from Bayer and Vifor; and research sup- .. Yadav R, Zembala MO; ESC Scientific Document Group. ESC/EACTS Guidelines
port from Amgen, AstraZeneca, Bayer, Fresenius Medical Care, and .. on myocardial revascularization. Eur Heart J 2019;40:87–165.
..
Genzyme. N.M.D. declared having equity ownership/stock options .. 11. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement

from Eli Lilly & Co. M.J and declared having received consultancy fees
.. DL, Coca A, de Simone G, Dominiczak A, Kahan T, Mahfoud F, Redon J, Ruilope
.. L, Zanchetti A, Kerins M, Kjeldsen SE, Kreutz R, Laurent S, Lip GYH, McManus
from Astellas, AstraZeneca, GlaxoSmithKline, MSD, and Vifor .. R, Narkiewicz K, Ruschitzka F, Schmieder RE, Shlyakhto E, Tsioufis C, Aboyans
.. V, Desormais I; ESC Scientific Document Group. 2018 ESC/ESH Guidelines for
Fresenius Medical Care Renal Pharma; speaker honoraria from .. the management of arterial hypertension. Eur Heart J 2018;39:3021–3104.
Abbvie, Amgen, Menarini, MSD, and Vifor Fresenius Medical Care .. 12. Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C,
..
Renal Pharma; travel support from Amgen; and research support .. Prescott E, Storey RF, Deaton C, Cuisset T, Agewall S, Dickstein K, Edvardsen T,

from Alexion, Amgen, Janssen-Cilag, Otsuka, and Roche. W.C.W. .. Escaned J, Gersh BJ, Svitil P, Gilard M, Hasdai D, Hatala R, Mahfoud F, Masip J,
.. Muneretto C, Valgimigli M, Achenbach S, Bax JJ; ESC Scientific Document Group.
declared having received consultancy fees from Akebia, AMAG, .. ESC Guidelines for the diagnosis and management of chronic coronary syn-
Amgen, AstraZeneca, Bayer, Daiichi-Sankyo, Relypsa, and ZS Pharma;
.. dromes. Eur Heart J 2020;41:407–477.
.. 13. Cosentino F, Grant PJ, Aboyans V, Bailey CJ, Ceriello A, Delgado V, Federici M,
speaker honoraria from FibroGen; and research support from .. Filippatos G, Grobbee DE, Hansen TB, Huikuri HV, Johansson I, Jüni P, Lettino
..
National Institutes of Health. All other authors declared no conflict .. M, Marx N, Mellbin LG, Östgren CJ, Rocca B, Roffi M, Sattar N, Seferovic PM,

of interest. .. Sousa-Uva M, Valensi P, Wheeler DC; ESC Scientific Document Group. ESC
.. Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in
.. collaboration with the EASD. Eur Heart J 2020;41:255–323.
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