CKD: A Call for an Age-Adapted Definition

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 m 2 . 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 m 2 , whereas in elderly people it is increased at levels <45 ml/min per 1.73 m 2 . 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.

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Affiliated Institutions

• KU Leuven BE
• University of Liège BE
• Assistance Publique – Hôpitaux de Paris FR
• Mayo Clinic US
• University of California, Los Angeles US
• Université Paris-Sud FR
• Amsterdam UMC Location University of Amsterdam NL
• Amsterdam University Medical Centers NL
• Charité - Universitätsmedizin Berlin DE
• Université Jean Monnet FR
• Lund University SE
• Hospices Civils de Lyon FR
• University of Verona IT
• University Medical Center Groningen NL
• Université de Montpellier FR
• Université Claude Bernard Lyon 1 FR
• University of Amsterdam NL
• University of Nottingham GB
• Centre Hospitalier Universitaire de Nîmes FR
• University of Iceland IS
• Freie Universität Berlin DE
• Centre Hospitalier Universitaire de Liège BE
• Centre Hospitalier Universitaire de Saint-Étienne FR
• Emma Kinderziekenhuis NL
• Hôpital Nord FR
• Skåne University Hospital SE
• Berlin Institute of Health at Charité - Universitätsmedizin Berlin DE
• UiT The Arctic University of Norway
• Queen's University CA
• Radboud University Medical Center NL
• University Hospital of North Norway
• Radboud University Nijmegen NL
• National University Hospital of Iceland IS

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