Chronic Kidney Disease: 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.

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.

• Journal Article Type: Article
• Publication Date: 2019-09
• Print ISSN: 1046-6673
• Publisher: American Society of Nephrology
• Peer Reviewed: Peer Reviewed
• Volume: 30
• Issue: 9
• APA6 Citation: Delanaye, P., Jager, K. J., Bökenkamp, A., Christensson, A., Dubourg, L., Eriksen, B. O., …van den Brand, J. A. (2019). Chronic Kidney Disease: call for an age-adapted definition. Journal of the American Society of Nephrology, 30(9), https://doi.org/10.1681/ASN.2019030238
• DOI: https://doi.org/10.1681/ASN.2019030238
• Publisher URL: https://jasn.asnjournals.org/content/early/2019/09/09/ASN.2019030238