Max Rady College of Medicine

Concept: Risk of Chronic Kidney Disease (CKD) Progression to End Stage Kidney Disease (ESKD) - Heat Map

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Concept Description

Last Updated: 2015-12-14


    This concept describes the methods developed to measure the risk of chronic kidney disease (CKD) progression to end stage kidney disease (ESKD) as it was used in the Care of Manitobans Living with Chronic Kidney Disease deliverable by Chartier et al. (2015). This includes the age groups applied, the data sources used, the code values and conditions identifying the ranges employed in the measurements, and additional conditions / restrictions that are applied. A "heat map", originally developed by the Kidney Disease Improving Global Outcomes (KDIGO) work group (2013) and adapted for use in our research, is described and illustrates the risk of progression to ESKD. A link to the adapted "heat map" used in the deliverable is also provided.

Technical Definition of Risk of Progression

The Heat Map - Mapping Categories of Risk

    To determine the likelihood of progression to ESKD, we adapted a "heat map" (a colour-coded classification table) developed in January 2013 by the Kidney Disease Improving Global Outcomes (KDIGO) Work Group (Kidney Disease Improving Global Outcomes (KDIGO), 2013). This new approach for prognosis of CKD was built on the recognition that albuminuria is an important marker of kidney function and risk of progression to ESKD, and it uses both albuminuria categories and eGFR to identify four levels of risk:

    • green: lowest risk (eGFR and albuminuria are normal or mildly abnormal)
    • yellow: moderately increased risk
    • orange: high risk
    • red: the highest risk of all.

    We modified this table by adding three additional categories to represent people with CKD who have an incomplete set of laboratory tests (one of the two laboratory tests, providing some indications of risk level) or who do not have any laboratory tests (unknown risk level). These additional categories included:

    • light purple: likely at lower risk
    • dark purple: likely at higher risk, and
    • white: unknown risk.

    In the event that only one of albuminuria or eGFR could be categorized, those who also met the administrative definition for CKD were assigned the following risk categories:

    • Low Risk: Albuminuria A1 or A2, or eGFR G1, G2 or G3a.
    • High Risk: Albuminuria A3 or eGFR G3b, G4 or G5.

    Those who met the administrative definition of CKD with no laboratory data to provide information about severity of risk were assigned to the Unknown Risk category.

    We combined all of these categories into three overall risk levels: low risk (green, yellow, and light purple), high risk (orange, red, and dark purple) and unknown risk (white). The low risk group includes people who might be in earlier stages of CKD, and the high risk group includes people who might be in later stages of CKD. We were not able to determine how advanced the disease is in people in the unknown risk group (white) because of lack of laboratory data and thus have no information about the impairment of kidney function.

    For more information on how the heat map was developed for this project, and a table illustrating the modified categories, see the section titled Risk of progression to ESKD in the deliverable.

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  • Chartier M, Dart A, Tangri N, Komenda P, Walld R, Bogdanovic B, Burchill C, Koseva I, McGowan K-L, Rajotte L. Care of Manitobans Living with Chronic Kidney Disease. Winnipeg, MB: Manitoba Centre for Health Policy, 2015. [Report] [Summary] [Updates and Errata] [Additional Materials] (View)
  • Kidney Disease Improving Global Outcomes (KDIGO). KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. 2013. Available from. [Report] (View)

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Manitoba Centre for Health Policy
Community Health Sciences, Max Rady College of Medicine,
Rady Faculty of Health Sciences,
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University of Manitoba
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