@article { , title = {Chronic Kidney Disease: call for an age-adapted definition}, abstract = {Current criteria for the diagnosis of chronic kidney disease (CKD) in adults include persistent signs of kidney damage; for example, increased urine albumin-to-creatinine ratio or a glomerular filtration rate (GFR) below the threshold of 60 mL/min per 1.73m2. The latter has important caveats. This threshold 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 pre-donation GFR compared to younger donors. Furthermore, the results of the large meta-analyses conducted by the CKD Prognosis Consortium and of 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 lower than 75 mL/min per 1.73m2, whereas in elderly people it is increased at levels lower than 45 mL/min per 1.73m2. Therefore, we suggest the CKD definition to be amended to include age-specific thresholds for GFR. The implications of an updated definition are far reaching. Fewer elderly would be diagnosed with CKD, reducing inappropriate care and its associated adverse effects. Prevalence estimates for CKD globally would be substantially reduced. Furthermore, the onset of CKD may be identified sooner in younger persons, and at a point when progressive kidney damage may still be preventable.}, doi = {10.1681/ASN.2019030238}, eissn = {1533-3450}, issn = {1046-6673}, issue = {9}, journal = {Journal of the American Society of Nephrology}, note = {When published: 12 month embargo, citation required. VEA 04.07.2019}, pages = {1785-1805}, publicationstatus = {Published}, publisher = {American Society of Nephrology}, url = {https://nottingham-repository.worktribe.com/output/2268784}, volume = {30}, keyword = {Nephrology, General Medicine}, year = {2019}, 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.} }