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 language | English (US) |
|---|---|
| Pages (from-to) | 1785-1805 |
| Number of pages | 21 |
| Journal | Journal of the American Society of Nephrology |
| Volume | 30 |
| Issue number | 10 |
| DOIs | |
| State | Published - Jan 1 2019 |
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ASJC Scopus subject areas
- Nephrology
Cite this
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 journal › Review article
}
TY - JOUR
T1 - CKD
T2 - A call for an age-adapted definition
AU - Delanaye, Pierre
AU - Jager, Kitty J.
AU - Bökenkamp, Arend
AU - Christensson, Anders
AU - Dubourg, Laurence
AU - Eriksen, Bjørn Odvar
AU - Gaillard, François
AU - Gambaro, Giovanni
AU - Van Der Giet, Markus
AU - Glassock, Richard J.
AU - Indridason, Olafur S.
AU - Van Londen, Marco
AU - Mariat, Christophe
AU - Melsom, Toralf
AU - Moranne, Olivier
AU - Nordin, Gunnar
AU - Palsson, Runolfur
AU - Pottel, Hans
AU - Rule, Andrew D.
AU - Schaeffner, Elke
AU - Taal, Maarten W.
AU - White, Christine
AU - Grubb, Anders
AU - Van Den Brand, Jan A.J.G.
PY - 2019/1/1
Y1 - 2019/1/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85072791003&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85072791003&partnerID=8YFLogxK
U2 - 10.1681/ASN.2019030238
DO - 10.1681/ASN.2019030238
M3 - Review article
C2 - 31506289
AN - SCOPUS:85072791003
VL - 30
SP - 1785
EP - 1805
JO - Journal of the American Society of Nephrology : JASN
JF - Journal of the American Society of Nephrology : JASN
SN - 1046-6673
IS - 10
ER -