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J Am Soc Nephrol. 2019 Oct;30(10):1785-1805. doi: 10.1681/ASN.2019030238. Epub 2019 Sep 10.

CKD: A Call for an Age-Adapted Definition.

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Department of Nephrology, Dialysis, Transplantation, University of Liège, Centre Hospitalier Universitaire Sart Tilman, ULg CHU, Liège, Belgium;
Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Emma Children's Hospital, Amsterdam UMC, Vrije University Amsterdam, Amsterdam, The Netherlands.
Department of Nephrology, Skåne University Hospital, Lund University, Malmö, Sweden.
Nephrology, Dialysis, Hypertension and Functional Renal Exploration, Edouard Herriot Hospital, Hospices Civils de Lyon and Université Lyon 1, Lyon, France.
Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway.
Section of Nephrology, Clinic of Internal Medicine, University Hospital of North Norway, Tromsø, Norway.
Renal Transplantation Department, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France, Paris Sud University, Orsay, France.
Division of Nephrology and Dialysis, Department of Medicine, University of Verona, Verona, Italy.
Department of Nephrology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Department of Medicine, Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
Division of Nephrology, National University Hospital of Iceland, Reykavik, Iceland.
Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands.
Nephrology, Dialysis and Renal Transplantation Department, Hôpital Nord, Centre Hospitalier Universitaire de Saint-Etienne, Jean Monnet University, Communauté d'universités et Etablissements Université de Lyon, Lyon, France.
Nephrology, Dialysis, Apheresis Unit, Centre Hospitalier Universitaire Caremeau Nimes, University of Montpellier, Montpellier, France.
Equalis AB, Uppsala, Sweden.
Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.
Department of Public Health and Primary Care, Katholieke Universiteit Leuven Campus Kulak Kortrijk, Kortrijk, Belgium.
Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota.
Charité - Universitätsmedizin Berlin, corporate member of Free University of Berlin, Humboldt University of Berlin, and Berlin Institute of Health, Institute of Public Health, Berlin, Germany.
Centre for Kidney Research and Innovation, Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, UK.
Department of Medicine, Queen's University, Kingston, Ontario, Canada.
Department of Clinical Chemistry and Pharmacology, Laboratory Medicine, Skåne University Hospital, Lund University, Lund, Sweden; and.
Department of Nephrology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.


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.


chronic kidney disease; epidemiology and outcomes; glomerular filtration rate

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