Glomerular Filtration Rate and Aging: Another Longitudinal Study - A Long Time Coming!

Delanaye, Pierre; Glassock, Richard J.

doi:10.1159/000439147

Cited by 11 publications

(9 citation statements)

References 24 publications

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“…Prospective longitudinal studies studying the slope of GFR in general or specific populations are scarce [19–22]. In 2015, Inker et al .…”

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confidence: 99%

“…In the same way, CV I or repeatability of UACR is very high (>50%), and this variability is higher in low UACR ranges (>100%) [32]. Together with the absence of proof of low eGFR chronicity, this non-confirmation of albuminuria (or proteinuria) in almost all epidemiological studies [7, 19] in the last 15 years results in false positivity of CKD prevalence of ≥50% [11]. In addition, since creatinine excretion is in the denominator of the UACR equation, variations in creatinine excretion can influence the results independent of true albumin excretion rates.…”

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confidence: 99%

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Epidemiology of chronic kidney disease: think (at least) twice!

Delanaye

Glassock²,

Broe

2017

Clinical Kidney Journal

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The introduction of the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines has substantially contributed to the early detection of different stages of chronic kidney disease (CKD). Several recent studies from different parts of the world mention a CKD prevalence of between 8 and 13%. There are several reasons the CKD prevalence found in a study of a particular population is clearly overestimated. The structure of the population pyramid (young or older age) of the study sample may result in high or low CKD prevalence. The absence of using an isotope dilution mass spectrometry creatinine assay can be the source of high bias in CKD prevalence. In addition, using an arbitrary single threshold of estimated glomerular filtration rate (eGFR; <60 mL/min/1.73 m2) for classifying CKD leads to a substantial ‘overdiagnosis’ (false positives) in the elderly (>65 years of age), particularly in those without albuminuria (or proteinuria), haematuria or hypertension. It also results in a significant ‘underdiagnosis’ (false negatives) in younger individuals with an eGFR >60 mL/min/1.73 m2 and below the third percentile for their age/gender category. The use of third percentile eGFR rates as a cut-off based on age/gender-specific reference values of eGFR allows the detection of these false positives and negatives. In the present article, we focus on an important and frequently omitted criterion in epidemiological studies: chronicity. Indeed, the two most important factors introducing a high number (up to 50%) of false positives are lack of confirming proteinuria and the absence of proof of chronicity of the eGFR found at first screening. There is an urgent need for quality studies of the prevalence of CKD using representative randomized samples of the population, applying the KDIGO guidelines correctly.

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“…Prospective longitudinal studies studying the slope of GFR in general or specific populations are scarce [19–22]. In 2015, Inker et al .…”

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confidence: 99%

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confidence: 99%

Epidemiology of chronic kidney disease: think (at least) twice!

Delanaye

Glassock²,

Broe

2017

Clinical Kidney Journal

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“…Clinical practice guidelines are available to assist clinicians in the evaluation and treatment of these complications and should be followed. 2 Of note, management is guided by the urine albumin-to-creatinine ratio (ACR) as well as by eGFR.…”

Section: Managing Chronic Kidney Disease In Older Peoplementioning

confidence: 99%

“…Such persons uncommonly display signs of a progressive form of kidney disease, other than the usually slow, agerelated decline in eGFR (most commonly <1 mL/min/1.73 m 2 per year), 2 and seldom develop a requirement for treatment of end-stage renal disease, 3,4 thus rendering the "diagnosis" of CKD doubtful.…”

Section: Conflict Of Interest Disclosuresmentioning

confidence: 99%

Managing Chronic Kidney Disease in Older People—Reply

Glassock

Delanaye

El‐Nahas

2016

JAMA

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In Reply Because our study was a phase 2B trial with the purpose of finding the optimal dosage with which to conduct a phase 3 outcome trial, strong conclusions should not be drawn from the results. Although Dr Feng and colleagues are correct that change in UACR at day 90 was the primary end point, we understand this is not consistent with any valid renal outcome and is a marker of inflammation and cardiovascular risk rather than renal injury. 1 We are fully aware of the variable relationship of high albuminuria and both kidney disease and cardiovascular outcomes from powered trials.We did not provide data on blood pressure variability because this was not a prespecified primary or secondary end point, although we are aware of the increased cardiovascular risk associated with increased blood pressure variability. We did perform ambulatory blood pressure monitoring in a subgroup of patients, and these data will be analyzed in the future.Hypotension was reported as an adverse event in less than 1% of patients; all events were of mild intensity, and none resulted in modification of drug therapy or any action with study drug.We appreciate the comment about dosing of ACE inhibitors and angiotensin receptor blockers contributing to greater effects on UACR; however, the study did not allow for titration of ACE inhibitors or angiotensin receptor blockers unless blood pressure was significantly elevated. In our trial, there was no significant uptitration of ACE inhibitors or angiotensin receptor blockers. Thus, the data are not confounded by increased dosing of other renin-angiotensin system-blocking therapies.We agree that outcome studies are needed and we have started studies involving 3 outcomes of diabetic kidney disease: kidney failure, cardiovascular outcomes, and heart failure. The first 2 trials are now recruiting patients and the heart failure trial will start within the next few months.

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“…One study showed that association between eGFR and mortality or ESRD ,60 ml/min per 1.73 m 2 was similar in young and elderly people (19). However, the calculation of hazard ratios is subject to several alternative interpretations (20). In addition, data from a large Canadian database confirmed that life expectancy was similar in elderly persons if stage 3A CKD or stage 1-2 CKD were compared (21).…”

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confidence: 99%