CKD: A call for an age-adapted definition

Pierre Delanaye, Kitty J. Jager, Arend Bökenkamp, Anders Christensson, Laurence Dubourg, Bjørn Odvar Eriksen, François Gaillard, Giovanni Gambaro, Markus Van Der Giet, Richard J. Glassock, Olafur S. Indridason, Marco Van Londen, Christophe Mariat, Toralf Melsom, Olivier Moranne, Gunnar Nordin, Runolfur Palsson, Hans Pottel, Andrew D. Rule, Elke SchaeffnerMaarten W. Taal, Christine White, Anders Grubb, Jan A.J.G. Van Den Brand

Research output: Contribution to journalReview article

4 Citations (Scopus)

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 singlenephron 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 1.73m2, 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 agespecific 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.

Original languageEnglish (US)
Pages (from-to)1785-1805
Number of pages21
JournalJournal of the American Society of Nephrology
Volume30
Issue number10
DOIs
StatePublished - Jan 1 2019

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Kidney
Mortality
Living Donors
Kidney Diseases
Meta-Analysis
Albumins
Creatinine
Tissue Donors
Urine
Health

ASJC Scopus subject areas

  • Nephrology

Cite this

Delanaye, P., Jager, K. J., Bökenkamp, A., Christensson, A., Dubourg, L., Eriksen, B. O., ... Van Den Brand, J. A. J. G. (2019). CKD: A call for an age-adapted definition. Journal of the American Society of Nephrology, 30(10), 1785-1805. https://doi.org/10.1681/ASN.2019030238

CKD : A call for an age-adapted definition. / Delanaye, Pierre; Jager, Kitty J.; Bökenkamp, Arend; Christensson, Anders; Dubourg, Laurence; Eriksen, Bjørn Odvar; Gaillard, François; Gambaro, Giovanni; Van Der Giet, Markus; Glassock, Richard J.; Indridason, Olafur S.; Van Londen, Marco; Mariat, Christophe; Melsom, Toralf; Moranne, Olivier; Nordin, Gunnar; Palsson, Runolfur; Pottel, Hans; Rule, Andrew D.; Schaeffner, Elke; Taal, Maarten W.; White, Christine; Grubb, Anders; Van Den Brand, Jan A.J.G.

In: Journal of the American Society of Nephrology, Vol. 30, No. 10, 01.01.2019, p. 1785-1805.

Research output: Contribution to journalReview article

Delanaye, P, Jager, KJ, Bökenkamp, A, Christensson, A, Dubourg, L, Eriksen, BO, Gaillard, F, Gambaro, G, Van Der Giet, M, Glassock, RJ, Indridason, OS, Van Londen, M, Mariat, C, Melsom, T, Moranne, O, Nordin, G, Palsson, R, Pottel, H, Rule, AD, Schaeffner, E, Taal, MW, White, C, Grubb, A & Van Den Brand, JAJG 2019, 'CKD: A call for an age-adapted definition', Journal of the American Society of Nephrology, vol. 30, no. 10, pp. 1785-1805. https://doi.org/10.1681/ASN.2019030238
Delanaye P, Jager KJ, Bökenkamp A, Christensson A, Dubourg L, Eriksen BO et al. CKD: A call for an age-adapted definition. Journal of the American Society of Nephrology. 2019 Jan 1;30(10):1785-1805. https://doi.org/10.1681/ASN.2019030238
Delanaye, Pierre ; Jager, Kitty J. ; Bökenkamp, Arend ; Christensson, Anders ; Dubourg, Laurence ; Eriksen, Bjørn Odvar ; Gaillard, François ; Gambaro, Giovanni ; Van Der Giet, Markus ; Glassock, Richard J. ; Indridason, Olafur S. ; Van Londen, Marco ; Mariat, Christophe ; Melsom, Toralf ; Moranne, Olivier ; Nordin, Gunnar ; Palsson, Runolfur ; Pottel, Hans ; Rule, Andrew D. ; Schaeffner, Elke ; Taal, Maarten W. ; White, Christine ; Grubb, Anders ; Van Den Brand, Jan A.J.G. / CKD : A call for an age-adapted definition. In: Journal of the American Society of Nephrology. 2019 ; Vol. 30, No. 10. pp. 1785-1805.
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