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CKD : A Call for an Age-Adapted Definition

Delanaye, Pierre ; Jager, Kitty J ; Bökenkamp, Arend ; Christensson, Anders LU ; Dubourg, Laurence ; Eriksen, Bjørn Odvar ; Gaillard, François ; Gambaro, Giovanni ; van der Giet, Markus and Glassock, Richard J , et al. (2019) In Journal of the American Society of Nephrology 30(10). p.1785-1805
Abstract

Current criteria for the diagnosis of CKD in adults include persistent signs of kidney damage, such as increased urine albumin-to-creatinine ratio or a GFR below the threshold of 60 ml/min per 1.73 m2 This threshold has important caveats because it does not separate kidney disease from kidney aging, and therefore does not hold for all ages. In an extensive review of the literature, we found that GFR declines with healthy aging without any overt signs of compensation (such as elevated single-nephron GFR) or kidney damage. Older living kidney donors, who are carefully selected based on good health, have a lower predonation GFR compared with younger donors. Furthermore, the results from the large meta-analyses conducted by the CKD... (More)

Current criteria for the diagnosis of CKD in adults include persistent signs of kidney damage, such as increased urine albumin-to-creatinine ratio or a GFR below the threshold of 60 ml/min per 1.73 m2 This threshold has important caveats because it does not separate kidney disease from kidney aging, and therefore does not hold for all ages. In an extensive review of the literature, we found that GFR declines with healthy aging without any overt signs of compensation (such as elevated single-nephron GFR) or kidney damage. Older living kidney donors, who are carefully selected based on good health, have a lower predonation GFR compared with younger donors. Furthermore, the results from the large meta-analyses conducted by the CKD Prognosis Consortium and from numerous other studies indicate that the GFR threshold above which the risk of mortality is increased is not consistent across all ages. Among younger persons, mortality is increased at GFR <75 ml/min per 1.73 m2, whereas in elderly people it is increased at levels <45 ml/min per 1.73 m2 Therefore, we suggest that amending the CKD definition to include age-specific thresholds for GFR. The implications of an updated definition are far reaching. Having fewer healthy elderly individuals diagnosed with CKD could help reduce inappropriate care and its associated adverse effects. Global prevalence estimates for CKD would be substantially reduced. Also, using an age-specific threshold for younger persons might lead to earlier identification of CKD onset for such individuals, at a point when progressive kidney damage may still be preventable.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Age Factors, Humans, Prognosis, Renal Insufficiency, Chronic/diagnosis
in
Journal of the American Society of Nephrology
volume
30
issue
10
pages
1785 - 1805
publisher
American Society of Nephrology
external identifiers
  • pmid:31506289
  • scopus:85072791003
ISSN
1046-6673
DOI
10.1681/ASN.2019030238
language
English
LU publication?
yes
additional info
Copyright © 2019 by the American Society of Nephrology.
id
121c4fab-96ff-4651-8d5f-a8c97bdd0e7b
date added to LUP
2021-11-03 08:13:18
date last changed
2022-10-02 19:36:12
@article{121c4fab-96ff-4651-8d5f-a8c97bdd0e7b,
  abstract     = {{<p>Current criteria for the diagnosis of CKD in adults include persistent signs of kidney damage, such as increased urine albumin-to-creatinine ratio or a GFR below the threshold of 60 ml/min per 1.73 m2 This threshold has important caveats because it does not separate kidney disease from kidney aging, and therefore does not hold for all ages. In an extensive review of the literature, we found that GFR declines with healthy aging without any overt signs of compensation (such as elevated single-nephron GFR) or kidney damage. Older living kidney donors, who are carefully selected based on good health, have a lower predonation GFR compared with younger donors. Furthermore, the results from the large meta-analyses conducted by the CKD Prognosis Consortium and from numerous other studies indicate that the GFR threshold above which the risk of mortality is increased is not consistent across all ages. Among younger persons, mortality is increased at GFR &lt;75 ml/min per 1.73 m2, whereas in elderly people it is increased at levels &lt;45 ml/min per 1.73 m2 Therefore, we suggest that amending the CKD definition to include age-specific thresholds for GFR. The implications of an updated definition are far reaching. Having fewer healthy elderly individuals diagnosed with CKD could help reduce inappropriate care and its associated adverse effects. Global prevalence estimates for CKD would be substantially reduced. Also, using an age-specific threshold for younger persons might lead to earlier identification of CKD onset for such individuals, at a point when progressive kidney damage may still be preventable.</p>}},
  author       = {{Delanaye, Pierre and Jager, Kitty J and Bökenkamp, Arend and Christensson, Anders and Dubourg, Laurence and Eriksen, Bjørn Odvar and Gaillard, François and Gambaro, Giovanni and van der Giet, Markus and Glassock, Richard J and Indridason, Olafur S and van Londen, Marco and Mariat, Christophe and Melsom, Toralf and Moranne, Olivier and Nordin, Gunnar and Palsson, Runolfur and Pottel, Hans and Rule, Andrew D and Schaeffner, Elke and Taal, Maarten W and White, Christine and Grubb, Anders and van den Brand, Jan A J G}},
  issn         = {{1046-6673}},
  keywords     = {{Age Factors; Humans; Prognosis; Renal Insufficiency, Chronic/diagnosis}},
  language     = {{eng}},
  number       = {{10}},
  pages        = {{1785--1805}},
  publisher    = {{American Society of Nephrology}},
  series       = {{Journal of the American Society of Nephrology}},
  title        = {{CKD : A Call for an Age-Adapted Definition}},
  url          = {{http://dx.doi.org/10.1681/ASN.2019030238}},
  doi          = {{10.1681/ASN.2019030238}},
  volume       = {{30}},
  year         = {{2019}},
}