The Joint Committee on Diabetes Nephropathy and The Working Group for Updated Staging of Diabetic Nephropathy 2023

Abstract

In Japan, the Classification (or Staging) of Diabetic Nephropathy revised in 2014 has been widely used. Since 2022, the Joint Committee on Diabetic Nephropathy has discussed the need to revisit the staging due to the diverse kidney phenotype in individuals with diabetes against the background of aging of the population, an increase in obese individuals, and the development of new therapeutic agents for diabetes and hypertension. As of now, no new evidence has been presented that suggest the necessity of changing the basic framework of the 2014 staging, which was based on the levels of albuminuria and estimated glomerular filtration rate. Therefore, the Committee has decided not to alter the fundamental structure of the 2014 staging. However, with a focus on maintaining consistency with the CKD classification by the Japanese Society for Nephrology and international notation, the former stages have been renamed as follows："normal albuminuria (stage 1)", "microalbuminuria (stage 2)", "macroalbuminuria (stage 3)", "severely decreased GFR/end-stage kidney disease (stage 4)", and "kidney replacement therapy (stage 5)".