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.
N1 - Funding Information:
Dr. Jager declared speaker honoraria from Fresenius and received grant support from European Renal Association – European Dialysis and Transplant Association. Dr. Schaeffner declared speaker honoraria from Fresenius Medical Care, Fresenius Kabi, and Siemens Health Care. Dr. White received grant support from Academic Health Science Center Alternate Funding Plan Innovation Fund. Dr. Melsom declared speaker honoraria from Astellas, Norwegian evening summit, American Society of Nephrology, 2018, and grants from Boehringer Ingelheim AS, outside the submitted work. Dr. van Londen declared speaker honoraria from Fresenius Medical Care. Dr. Rule declared royalties as “UpToDate” author on “The Aging Kidney.” Dr. van der Giet reports personal fees from Novartis, personal fees from Bayer, personal fees and “other” from IEM, personal fees and other from Charité Research Organization, grants from Deutsche For-schungsgemeinschaft, grants from Else Kröner Freseniusstiftung, personal fees from Berlin Chemie, personal fees from Otsuka, personal fees from Servier, and personal fees from CVRX, outside the submitted work. Dr. Glassock reports other from Wolters-Kluwer, outside the submitted work. Dr. Rule reports grants from National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, during the conduct of the study. All authors are members of the ERA-EDTA European Kidney Function Consortium.
PY - 2019
Y1 - 2019
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.
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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 -