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 articleAcademicpeer-review

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

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