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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">To the Editor&#44; </span></p><p class="elsevierStylePara">Chronic kidney disease &#40;CKD&#41; is a common&#44; treatable health issue that is well-known around the world&#46; Although it is difficult to evaluate the repercussions that the various approximations to structuring the disease in recent years have had&#58; a&#41; classification of CKD according to the <span class="elsevierStyleItalic">NKF-KDOQI 2002</span><span class="elsevierStyleItalic"><span class="elsevierStyleSup">1</span></span><span class="elsevierStyleItalic">&#59; b</span>&#41; consensus from the MDRD<span class="elsevierStyleSup">2</span> for estimating glomerular filtration rate &#40;eGFR&#41;&#44; and&#47;or c&#41; amplification of the use of albumin&#47;creatinine ratios &#40;ACR&#41;&#44;<span class="elsevierStyleSup">3</span> their importance has been&#44; without a doubt&#44; very substantial&#44; especially in non-nephrological fields&#46;</p><p class="elsevierStylePara">However&#44; nothing is perfect&#44; and several studies have demonstrated that proteinuria should be considered as an independent risk factor&#44; both for the progression of CKD and mortality&#46; As such&#44; it would be logical to include this measure as a parameter used for stratifying patients with this disease&#46; In this sense&#44; the Kidney Disease&#58; Improving Global Outcomes &#40;KDIGO&#41; has promoted several initiatives&#46;<span class="elsevierStyleSup">4&#44;5</span> Tonelli&#44; et al<span class="elsevierStyleSup">6</span> presented their proposal for a new classification system based on risk categories&#44; including proteinuria and eGFR&#44; comparing it to the KDOQI-2002 in terms of referrals to nephrological consultations&#46; In the accompanying editorial&#44; Levey&#44; et al<span class="elsevierStyleSup">5</span> refer to another similar classification&#44; but one that adds more categories of proteinuria &#40;KDIGO-2009 proposal&#41; &#40;Figure 1&#41;&#46;</p><p class="elsevierStylePara">Recently&#44; in the yearly meeting of the GRUPERVA in Granada&#44; we presented the proposals of Levey<span class="elsevierStyleSup">5</span> and Tonelli<span class="elsevierStyleSup">6 </span>as &#8220;the promising future in store for us&#44;&#8221; primarily from a non-nephrological point of view&#44; and we analysed their application in our field of medicine&#46;</p><p class="elsevierStylePara">We used paired measurements &#40;M&#41; of glucohaemoglobin A<span class="elsevierStyleInf">1c </span>&#40;HbA<span class="elsevierStyleInf">1C</span>&#41; and fasting blood glucose levels &#40;FBG&#41; from our health area between September 2009 and February 2010 that were derived from primary care &#40;PC&#41; and hospital care &#40;HC&#41; settings&#46; We assumed that the majority of measurements were taken from diabetic or pre-diabetic patients&#44; which would give greater weight to the prognostic value of proteinuria&#46;</p><p class="elsevierStylePara">First we sought to explore whether&#44; as the guidelines indicate&#44; these measurements were accompanied by a kidney profile &#40;eGFR and ACR&#41;&#44; and secondly&#44; we evaluated the influence of classifying according to the KDOQI-2002<span class="elsevierStyleSup">1</span><span class="elsevierStyleSup">&#160;</span>or Tonelli&#44; 2011<span class="elsevierStyleSup">6</span> systems &#40;we opted for this method since it was more simple&#41;&#46;</p><p class="elsevierStylePara">We accumulated a total of 3953 valid measurements&#44; 3018 of which &#40;76&#37;&#41; were from PC and 935 &#40;24&#37;&#41; were from HC&#46; In our sample&#44; 2169 patients &#40;55&#37;&#41; were women &#40;M&#47;W&#41;&#44; and the rest&#44; 1784&#44; were men &#40;M&#47;M&#41;&#46; The M of A<span class="elsevierStyleInf">1c</span>&#47;FGP were accompanied by requests for creatinine measurements in 98&#37; of cases&#44; eGFR in 72&#37;&#44; and ACR in 67&#37;&#46; If we compare by the origin of the patient &#40;PC vs HC&#41;&#44; creatinine levels were requested in 98&#37; vs 98&#37; &#40;NS&#41;&#44; eGFR was requested in 77&#37; vs 54&#37; &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;01&#41;&#44; and ACR was requested in 74&#37; vs 46&#37; of cases &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;01&#41;&#46;</p><p class="elsevierStylePara">The results obtained from using the two classifications mentioned are summarised in Figure 2&#46; In accordance with Tonelli&#44; 2011&#44; the low-risk situations &#40;categories 0 and 1&#41; increase&#44; the moderate risk situations &#40;2 and 3&#41; decrease&#44; and high-risk &#40;category 4&#41; also increase&#46;</p><p class="elsevierStylePara">In spite of the usual biases inherent to observational retrospective studies that only examine measurements&#44; we can state that&#58; firstly&#44; the normal evaluation of renal profiles is not correctly carried out&#44; not all of the recommended parameters are requested&#59; secondly&#44; applying the new classifications&#44; the highly debated level 3 of the KDOQI&#44; 2002 decreases&#44; due to the inclusion of proteinuria&#44; provoking those patients that do not have this condition to descend to a lower category&#44; whereas those that do are raised in category&#59; and as such&#44; lastly&#44; the use of the new classifications can give greater reliability to the categorisation of patients at risk of CKD&#44; and consequently improve the quality of referrals to nephrological consultations&#46;</p><p class="elsevierStylePara"><a href="grande&#47;11025&#95;108&#95;25064&#95;en&#95;11025&#95;f1&#46;jpg" class="elsevierStyleCrossRefs"><img src="11025_108_25064_en_11025_f1.jpg" alt="Proposal of a new classification system of chronic kidney disease by Tonelli&#44; et al &#40;ref&#46; 6&#41;"></img></a></p><p class="elsevierStylePara">Figure 1&#46; Proposal of a new classification system of chronic kidney disease by Tonelli&#44; et al &#40;ref&#46; 6&#41;</p><p class="elsevierStylePara"><a href="grande&#47;11025&#95;108&#95;25065&#95;en&#95;11025&#95;f2&#46;jpg" class="elsevierStyleCrossRefs"><img src="11025_108_25065_en_11025_f2.jpg" alt="Comparative results of the application of the different chronic kidney disease classifications to measurements from our studies "></img></a></p><p class="elsevierStylePara">Figure 2&#46; Comparative results of the application of the different chronic kidney disease classifications to measurements from our studies </p>"
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