American Journal of Kidney Diseases
Volume 52, Issue 4 , Page 803, October 2008

CKD in the Elderly

Article Outline

 

To the Editor:

We write in response to the editorial by Stevens, Coresh, and Levey1 concerning “CKD in the Elderly—Old Questions and New Challenges” marking World Kidney Day 2008.

Use of the Kidney Disease Outcomes Quality Initiative (KDOQI) definition of chronic kidney disease (CKD)2 and the Modification of Diet in Renal Disease Study equation (or its Chinese modification)1, 2, 3 for estimated glomerular filtration rate (eGFR) to establish the prevalence of CKD will predictably lead to the finding of CKD in a daunting proportion of the elderly (age ≥ 70 years); 47% in the United States and 30% in China.1 We suggest that the majority of such CKD is an “artifact” explained by the natural decrease in eGFR with aging (related to organ senescence)4 and the absolute threshold of eGFR to define stage 3 CKD.2 Stage 3 CKD constitutes a substantial fraction of “diagnosed” CKD in both the United States (77%) and China (36%) in the elderly.1 Application of an absolute threshold of eGFR without adjustment for age and sex for diagnosing CKD will cause the prevalence of CKD to track with the distribution of age and eGFR in the population at large.5

We question the purpose of asserting that so many individuals have a chronic disease. We disagree that it is helpful to label individuals with an eGFR lower than that found in youth as having CKD. Physicians already handle the elderly with care; this “disease” prompt is unnecessary.

More research is needed, but we should not aggravate the burden of growing older by adding the pejorative label of CKD, which can only be justified if it mandates extra specific measures that add value to the care of elderly patients. Why not describe these older patients as having “age-related reduced kidney function,” reassuring them that neither death nor dialysis therapy is imminent?

The current KDOQI CKD construct has succeeded in increasing awareness of the neglected problem of CKD. It now needs to be redesigned to improve both diagnosis and prognosis of “true” CKD. Yes, true CKD is common (but not dauntingly so), harmful (more in the young than in the elderly), and treatable (but how should not be assumed to be known). Let us improve the definition of CKD in the elderly by World Kidney Day 2009.

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Acknowledgements 

Support: None.

Financial Disclosure: None.

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References 

  1. Stevens LA, Coresh J, Levey AS. CKD in the elderly—Old questions and new challenges: World Kidney Day 2008. Am J Kidney Dis. 2008;51:353–357
  2. National Kidney Foundation. KDOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, classification, and stratification. Am J Kidney Dis. 2002;39(suppl 1):S46–S76
  3. Ma Y-C, Zuo L, Chen J-H, et al. Modified glomerular filtration rate estimation equation for Chinese patients with chronic kidney disease. J Am Soc Nephrol. 2006;17:2937–2944
  4. Wetzels JFM, Kiemeney LA, Swinkels DW, et al. Age- and gender-specific reference values of estimated GFR in Caucasians: The Nijmegen Biomedical Study. Kidney Int. 2007;72:632–637
  5. Glassock RJ, Winearls C. Epidemic of chronic kidney disease: Fact or fiction?. Nephrol Dial Transplant. 2008;23:1117–1121

PII: S0272-6386(08)01183-9

doi:10.1053/j.ajkd.2008.07.017

Refers to article:

  • CKD in the Elderly—Old Questions and New Challenges: World Kidney Day 2008

    Lesley A. Stevens, Josef Coresh, Andrew S. Levey
    American Journal of Kidney Diseases March 2008 (Vol. 51, Issue 3, Pages 353-357)

  • In Reply to ‘CKD in the Elderly’

    Lesley A. Stevens, Josef Coresh, Andrew S. Levey
    American Journal of Kidney Diseases October 2008 (Vol. 52, Issue 4, Pages 803-804)

American Journal of Kidney Diseases
Volume 52, Issue 4 , Page 803, October 2008

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