An epidemic of chronic kidney disease: fact or fiction?

Glassock, Richard J.; Winearls, Christopher G.

doi:10.1093/ndt/gfn086

Cited by 165 publications

(129 citation statements)

References 27 publications

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“…In the PREVEND (Prevention of Renal and Vascular Endstage Disease) study in the Netherlands, in a population-based cohort, the prevalence of Stage 3 CKD (eGFR 30-60 mL/min/1.73 m 2 ) was 5.3%, and 0.04%, and <0.04% for Stages 4 and 5 CKD (eGFR 15-30 mL/min/1.73 m 2 and <15 mL/min, respectively) (3). These numbers are comparable to NHANES (National Health and Nutrition Examination Survey) data from the United States (4,5). As renal function declines with age, the percentage of patients with CKD progressively increases with advancing age: up to 42% in men and 44% in women of age 85 and higher, which mainly concerns subjects with Stage 3 CKD (6).…”

Section: Glomerular Filtration Rate and Classification Of Chronic Kidsupporting

confidence: 66%

Estimation of renal function in patients with chronic kidney disease

Kooman

2009

Magnetic Resonance Imaging

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The risk of nephrogenic systemic fibrosis after gadolinium exposure is inversely related to renal function. Various methods are available to assess the glomerular filtration rate (GFR). Prediction formulas based on serum creatinine, such as the abbreviated Modification of Diet in Renal Disease (MDRD) formula, are most commonly used and appear acceptable for clinical purposes in the majority of patients with chronic renal failure. However, especially in patients at the extremes of body composition, the results from creatinine‐based equations should be interpreted with caution. In those patients, additional methods, such as timed urine collections, predictions based on cystatin, single‐shot radiotracer methods, or, optimally, inulin clearance could be considered. In this review, the strengths and limitations of different methods to assess GFR are discussed. Apart from inulin clearance, no method can be considered the gold standard in the assessment of GFR. In cases of doubt, the decision to use gadolinium‐enhanced magnetic resonance imaging should always be based on clinical risk–benefit judgment. J. Magn. Reson. Imaging 2009;30:1341–1346. © 2009 Wiley‐Liss, Inc.

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Section: Glomerular Filtration Rate and Classification Of Chronic Kidsupporting

confidence: 66%

Estimation of renal function in patients with chronic kidney disease

Kooman

2009

Magnetic Resonance Imaging

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“…Because this is a cross-sectional analysis, we do not have repeated creatinine measurements in our sample to indicate chronicity. The high prevalence rates may continue the debate about current cutoffs used to define CKD in older adults (55). Whereas our cross-sectional analysis cannot answer this question, we hope that longitudinal followup data from BIS will help resolve whether CKD staging in older adults needs to be redefined.…”

Section: Discussionmentioning

confidence: 90%

Two Novel Equations to Estimate Kidney Function in Persons Aged 70 Years or Older

Schaeffner¹,

Ebert²,

Delanaye³

et al. 2012

Ann Intern Med

498

439

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Background: In older adults, current equations to estimate glomerular filtration rate (GFR) are not validated and may misclassify elderly persons in terms of their stage of chronic kidney disease. Objective: To derive the Berlin Initiative Study (BIS) equation, a novel estimator of GFR in elderly participants. Design: Cross-sectional. Data were split for analysis into 2 sets for equation development and internal validation. Setting: Random community-based population of a large insurance company. Participants: 610 participants aged 70 years or older (mean age, 78.5 years). Intervention: lohexol plasma clearance measurement as gold standard. Measurements: GFR, measured as the plasma clearance of the endogenous marker iohexol, to compare performance of existing equations of estimated GFR with measured GFR of the gold standard; estimation of measured GFR from standardized creatinine and cystatin C levels, sex, and age in the learning sample; and comparison of the BIS equations (BIS1: creatinine-based; BIS2: creatinine-and cystatin C-based) with other estimating equations and determination of bias, precision, and accuracy in the validation sample. Results:The new BIS2 equation yielded the smallest bias followed by the creatinine-based BIS1 and CockcroftGault equations. All other equations considerably overestimated GFR. The BIS equations confirmed a high prevalence of persons older than 70 years with a GFR less than 60 mL/min per 1.73 m 2 (BIS1, 50.4%; BIS2, 47.4%; measured GFR, 47.9%). The total misclassification rate for this criterion was smallest for the BIS2 equation (11.6%), followed by the cystatin C equation 2 (15.1%) proposed by the Chronic Kidney Disease Epidemiology Collaboration. Among the creatinine-based equations, BIS1 had the smallest misclassification rate (17.2%), followed by the Chronic Kidney Disease Epidemiology Collaboration equation (20.4%). Limitation: There was no validation by an external data set. Conclusion: The BIS2 equation should be used to estimate GFR in persons aged 70 years or older with normal or mild to moderately reduced kidney function. If cystatin C is not available, the BIS1 equation is an acceptable alternative. Primary Funding Source: Kuratorium für Dialyse und Nierentransplatation (KfH) Foundation of Preventive Medicine.

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“…Proper treatment requires precision in diagnosis. As we have pointed out elsewhere, these values of eGFR overlap extensively with the normal age-and gender-adjusted values for eGFR (8). The consequence of this flaw is very significant in that it categorizes a substantial fraction of otherwise normal, healthy older individuals (over age 65 yr) as having CKD stage 3 when they do not have any clinically relevant abnormality.…”

Section: Egfr Is Unreliable In Defining Ckdmentioning

confidence: 84%

“…The addition of abnormal albuminuria as a requirement for defining CKD stage 3 would reduce the estimates of prevalence of CKD even further (11). We postulate that if these adjustments were made in the definition of what constitutes "authentic" CKD, that the overall prevalence rate of stage 3 CKD in the population-at-large would be shown to have remained relatively constant over the past several decades (at least in the United States), as we have argued elsewhere (8). Another source of error, often neglected in population-wide surveys, is that a single serum creatinine concentration is unreliable in assessing chronicity of disease.…”

Section: Egfr Is Unreliable In Defining Ckdmentioning

confidence: 87%

“…Thus, CKD prevalence will track with age and with eGFR. A simple adjustment of the threshold for defining CKD stage 3 by use of percentiles of eGFR for age and gender derived from healthy cohorts would eliminate this flaw and reduce the estimated prevalence of CKD in the community to more credible levels (5,8). The addition of abnormal albuminuria as a requirement for defining CKD stage 3 would reduce the estimates of prevalence of CKD even further (11).…”

Section: Egfr Is Unreliable In Defining Ckdmentioning

confidence: 99%

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Screening for CKD with eGFR

Glassock

Winearls

2008

Clinical Journal of the American Society of Nephrology

155

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The early identification of chronic kidney disease (CKD) is a legitimate enterprise if it provides meaningful opportunities for effective and safe interventions that reduce the risk of death, end-stage renal disease, or complications of renal dysfunction. The screening of unselected populations not already known to be at risk of CKD has the potential of harm and has not been shown to be cost-effective. The application of formulas for the estimation of GFR (eGFR) to the guidelines for staging of chronic kidney disease (Kidney Disease Outcomes Quality Initiative, K/DOQI) as universal screening tools is of dubious value and has inherent dangers. This conclusion is based both on the unreliability of current formulas for determining eGFR and flaws in the K/DOQI schema for staging of CKD. The failure to take into account the normal age-and gender-associated decline in GFR and the lack of a requirement for other evidence of kidney disease in CKD stage 3 leads to an erroneous categorization of large numbers of mostly elderly and female subjects as having an intermediate stage of a lethal disease. Criteria for CKD staging should take into account the percentile distribution of eGFR by age and gender. Targeted screening for CKD is likely to be more cost-effective than universal screening. Whether early identification and treatment of subjects with "reduced" levels of GFR within the normal range for their age/gender, but without any other manifestations of kidney disease, will reduce the subsequent risk of cardiovascular events or progression to end-stage-renal disease is currently unproven.

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An epidemic of chronic kidney disease: fact or fiction?

Cited by 165 publications

References 27 publications

Estimation of renal function in patients with chronic kidney disease

Estimation of renal function in patients with chronic kidney disease

Two Novel Equations to Estimate Kidney Function in Persons Aged 70 Years or Older

Screening for CKD with eGFR

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