CKD: A Call for an Age-Adapted Definition
Pierre Delanaye
(1)
,
Kitty Jager
(2)
,
Arend Bökenkamp
(2, 3)
,
Anders Christensson
(4)
,
Laurence Dubourg
(5)
,
Bjørn Odvar Eriksen
(6)
,
François Gaillard
(7)
,
Giovanni Gambaro
(8)
,
Markus van Der Giet
(9)
,
Richard Glassock
(10)
,
Olafur Indridason
(11)
,
Marco van Londen
(12)
,
Christophe Mariat
(13, 14)
,
Toralf Melsom
(6)
,
Olivier Moranne
(15, 16)
,
Gunnar Nordin
,
Runolfur Palsson
(11, 17)
,
Hans Pottel
(18)
,
Andrew Rule
(19)
,
Elke Schaeffner
(9, 20, 21)
,
Maarten Taal
(22)
,
Christine White
(23)
,
Anders Grubb
(4)
,
Jan a J G van den Brand
(24)
1
CHU-Liège -
Centre Hospitalier Universitaire de Liège
2 AMC - Academic Medical Center - Academisch Medisch Centrum [Amsterdam]
3 VU - Vrije Universiteit Amsterdam [Amsterdam]
4 Skane University Hospital [Malmo]
5 Hôpital Edouard Herriot [CHU - HCL]
6 UiT - The Arctic University of Norway [Tromsø, Norway]
7 Service Néphrologie et transplantation rénale Adultes [CHU Necker]
8 UNIVR - Università degli studi di Verona = University of Verona
9 Charité - UniversitätsMedizin = Charité - University Hospital [Berlin]
10 David Geffen School of Medicine [Los Angeles]
11 Landspitali National University Hospital of Iceland
12 UMCG - University Medical Center Groningen [Groningen]
13 CHU ST-E - Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne]
14 UJM - Université Jean Monnet - Saint-Étienne
15 CHU Nîmes - Centre Hospitalier Universitaire de Nîmes
16 AIDMP - Aide à la Décision pour une Médecine Personnalisé - Laboratoire de Biostatistique, Epidémiologie et Recherche Clinique - EA 2415
17 University of Iceland [Reykjavik]
18 UCL - Université Catholique de Louvain = Catholic University of Louvain
19 Mayo Clinic [Rochester]
20 HU Berlin - Humboldt-Universität zu Berlin = Humboldt University of Berlin = Université Humboldt de Berlin
21 BIH - Berlin Institute of Health
22 UON - University of Nottingham, UK
23 Queen's University [Kingston, Canada]
24 Radboud University Medical Center [Nijmegen]
2 AMC - Academic Medical Center - Academisch Medisch Centrum [Amsterdam]
3 VU - Vrije Universiteit Amsterdam [Amsterdam]
4 Skane University Hospital [Malmo]
5 Hôpital Edouard Herriot [CHU - HCL]
6 UiT - The Arctic University of Norway [Tromsø, Norway]
7 Service Néphrologie et transplantation rénale Adultes [CHU Necker]
8 UNIVR - Università degli studi di Verona = University of Verona
9 Charité - UniversitätsMedizin = Charité - University Hospital [Berlin]
10 David Geffen School of Medicine [Los Angeles]
11 Landspitali National University Hospital of Iceland
12 UMCG - University Medical Center Groningen [Groningen]
13 CHU ST-E - Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne]
14 UJM - Université Jean Monnet - Saint-Étienne
15 CHU Nîmes - Centre Hospitalier Universitaire de Nîmes
16 AIDMP - Aide à la Décision pour une Médecine Personnalisé - Laboratoire de Biostatistique, Epidémiologie et Recherche Clinique - EA 2415
17 University of Iceland [Reykjavik]
18 UCL - Université Catholique de Louvain = Catholic University of Louvain
19 Mayo Clinic [Rochester]
20 HU Berlin - Humboldt-Universität zu Berlin = Humboldt University of Berlin = Université Humboldt de Berlin
21 BIH - Berlin Institute of Health
22 UON - University of Nottingham, UK
23 Queen's University [Kingston, Canada]
24 Radboud University Medical Center [Nijmegen]
Pierre Delanaye
- Fonction : Auteur
- PersonId : 772089
- ORCID : 0000-0002-1480-5761
Arend Bökenkamp
- Fonction : Auteur
- PersonId : 801379
- ORCID : 0000-0002-3492-2252
François Gaillard
- Fonction : Auteur
- PersonId : 768575
- ORCID : 0000-0002-7248-8418
- IdRef : 232808392
Olivier Moranne
- Fonction : Auteur
- PersonId : 754796
- IdHAL : olivier-moranne
- ORCID : 0000-0002-3127-1415
Gunnar Nordin
- Fonction : Auteur
Hans Pottel
- Fonction : Auteur
- PersonId : 771242
- ORCID : 0000-0003-0074-8919
Anders Grubb
- Fonction : Auteur
- PersonId : 801382
- ORCID : 0000-0002-0125-3662
Jan a J G van den Brand
- Fonction : Auteur
- PersonId : 1052130
Résumé
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.