Risks of Changing Estimated Glomerular Filtration Rate Thresholds in Older Persons

Cruz-Jentoft, A.J.

doi:10.1001/jamainternmed.2021.7344

Cited by 3 publications

(4 citation statements)

References 8 publications

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“…The grouping of the fourth physical examination results was performed according to age (the subjects in this physical examination were all older than 30 years); the prevalence of CKD in the 30-39-year age group was 12.0%, the prevalence of CKD in the 40-49-year age group was 9.8%, and no one in the over 50 age group had CKD. Since age is a known risk factor for CKD, previous studies have also shown that the overall prevalence of CKD increases with age [4], but the results of this study showed that the prevalence of CKD decreased with increasing age and that the incidence rate in the 30-39-year age group (12.0%) was the highest. A possible reason for this finding is that the subjects in this study are aircrew members, and thus, if they have a medical condition, they cannot continue to serve in the Air Force; in this study, early-stage CKD (stages 1 and 2) is dominant, and the GFR is still within the normal range; however, to diagnose early-stage CKD, renal parenchymal damage is required (at least one item of urine protein, urine RBC positivity, or urine pH > 8), thus reducing the explanatory power of age on the risk of early-stage CKD.…”

Section: Comparison Of Ckd and The Number Of Abnormal Predictorscontrasting

confidence: 81%

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Biomedical Evaluation of Early Chronic Kidney Disease in the Air Force: Building a Predictive Model from the Taiwan Military Health Service

Hsiao,

Wang,

et al. 2024

Bioengineering

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Objective: Chronic kidney disease (CKD) is one of the most common diseases worldwide. The increasing prevalence and incidence of CKD have contributed to the critical problem of high medical costs. Due to stressful environments, aircrew members may have a high risk of renal dysfunction. A better strategy to prevent CKD progression in Air Force personnel would be to diagnosis CKD at an early stage. Since few studies have been conducted in Taiwan to examine the long-term trends in early CKD in Air Force aircrew members, this study is highly important. We investigated the prevalence of CKD and established a predictive model of disease variation among aircrew members. Materials and Methods: In this retrospective study, we included all subjects who had received physical examinations at a military hospital from 2004 to 2010 and who could be tracked for four years. The Abbreviated Modification of Diet in Renal Disease Formula (aMDRD) was used to estimate the glomerular filtration rate (GFR) and was combined with the National Kidney Foundation/ Kidney Disease Outcomes Quality Initiative (NKF-K/DOQI) to identify CKD patients. Results: A total of 212 aircrew members were assessed. The results showed that the prevalence of CKD was 3.8%, 9.4%, 9.0%, and 9.4% in each of the four years. According to the logistic regression analysis, abnormal urobilinogen levels, ketones, and white blood cell (WBC) counts in urine and a positive urine occult blood test increased the risk of CKD. A positive urine occult blood test can be used to predict the future risk of CKD. Moreover, the generalized estimating equation (GEE) model showed that a greater risk of CKD with increased examination time, age and seniority had a negative effect. In conclusion, abnormal urobilinogen levels, ketones, and urine WBC counts in urine as well as a positive urine occult blood test might serve as independent predictors for CKD. Conclusion: In the future, we can focus not only on annual physical examinations but also on simple and accurate examinations, such as urine occult blood testing, to determine the risk of CKD and prevent its progression in our aircrew members.

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Section: Comparison Of Ckd and The Number Of Abnormal Predictorscontrasting

confidence: 81%

“…Spearman correlation coefficient: the relationships between risk factors and renal function were analysed. 4.…”

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confidence: 99%

Biomedical Evaluation of Early Chronic Kidney Disease in the Air Force: Building a Predictive Model from the Taiwan Military Health Service

Hsiao,

Wang,

et al. 2024

Bioengineering

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“…In this regard, another relevant point is the current debate about the suggested agedependent CKD definition. Nephrologists are still arguing whether isolated mild eGFR reductions to a level just below 60 ml/min/1.73 m 2 should even be considered a disease in older adults (Delanaye et al, 2019;Cruz-Jentoft, 2022;Liu et al, 2022). Considering the effect of comorbidity and renal senescence on Frontiers in Pharmacology frontiersin.org eGFR decline (Glassock et al, 2020), many authors suggest avoiding the use of a "one-size-fits-all approach" for CKD diagnosis and to rethink CKD definition to include agespecific eGFR thresholds (Delanaye et al, 2019;Glassock et al, 2020).…”

Section: Chronic Kidney Disease Underdiagnosismentioning

confidence: 99%

A focus on CKD reporting and inappropriate prescribing among older patients discharged from geriatric and nephrology units throughout Italy: A nationwide multicenter retrospective cross-sectional study

et al. 2022

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Older hospitalized patients with chronic kidney disease (CKD) are part of the geriatric population with a substantial risk of potentially inappropriate medication (PIM) use. The high rates of multimorbidity and polypharmacy, along with the progressive decline of eGFR, contribute to increasing the risk of drug–drug and drug–disease interactions, overdosing, and adverse drug reactions (ADRs). In this multicenter cross-sectional study, we aimed to evaluate the prevalence of CKD under-reporting and PIMs among older patients discharged from acute geriatric and nephrology units throughout Italy. Renal function was determined by estimated glomerular filtration rate (eGFR) through the Berlin Initiative Study (BIS) equation; the prevalence of PIMs was calculated by revising drug prescriptions at discharge according to STOPP criteria, Beers criteria, and summaries of product characteristics (smPCs). A descriptive analysis was performed to compare the clinical and pharmacological characteristics of patients in the two distinct settings; univariate and multivariate logistic regression models were performed to explore factors associated with CKD under-reporting in the discharge report forms and PIM prevalence. Overall, the study population consisted of 2,057 patients, aged 83 (77–89) years, more commonly women, with a median of seven (5–10) drugs prescribed at discharge. CKD under-reporting was present in 50.8% of the study population, with higher rates in geriatric vs. nephrology units (71.1% vs. 10.2%, p < 0.001). 18.5% of the study population was discharged with at least one renally inappropriate medication; factors associated with at least one contraindicated drug at discharge were the number of drugs (PR 1.09, 95% CI 1.14–1.19); atrial fibrillation (PR 1.35, 95% CI 1.01–1.81); diabetes (PR 1.61, 95% CI 1.21–2.13); being hospitalized in nephrology units (PR 1.62, 95% CI 1.14–2.31), CKD stage 3b (PR 2.35, 95% CI 1.34–4.13), and stage 4–5 (PR 14.01, 95% CI 7.36–26.72). Conversely, CKD under-reporting was not associated with the outcome. In summary, CKD under-reporting and inappropriate medication use were common in older patients discharged from hospital; the relatively high number of PIMs in both nephrology and geriatric settings underlines the need to improve appropriate prescribing during hospital stay and to decrease the risk of ADRs and side effects in this highly vulnerable population.

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“…Adapting chronic kidney disease (CKD) definition to age is a matter of debate [ 1 , 2 ]. The threshold for defining CKD stage 3a has been suggested to be changed to estimated glomerular filtration rate (eGFR) < 45 ml/min/1.73 m 2 , to account for expected changes in eGFR with normal ageing, avoid overdiagnosis and provide CKD diagnostic and classification systems that are less discriminatory toward the ever-expanding older component of the global population [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

The relevance of geriatric assessments on the association between chronic kidney disease stages and mortality among older people: a secondary analysis of a multicentre cohort study

et al. 2022

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Background age-adapted definition of chronic kidney disease (CKD) does not take individual risk factors into account. We aimed at investigating whether functional impairments influence CKD stage at which mortality increases among older people. Methods our series consisted of 2,372 outpatients aged 75 years or more enrolled in a multicentre international prospective cohort study. The study outcome was 24-month mortality. Kidney function was assessed by estimated glomerular filtration rate (eGFR) and albumin-to-creatinine ratio (ACR). Geriatric assessments included handgrip strength, short physical performance battery (SPPB), cognitive impairment, dependency in basic activities of daily living (BADL) and risk of malnutrition. Analysis was carried out by Cox regression, before and after stratification by individual functional impairments. Survival trees including kidney function and functional impairments were also investigated, and their predictivity assessed by C-index. Results overall, mortality was found to increase starting from eGFR = 30–44.9 ml/min/1.73 m2 (hazard ratio [HR] = 3.28, 95% confidence interval [CI] = 1.81–5.95) to ACR = 30–300 mg/g (HR = 1.96, 95%CI = 1.23–3.10). However, in survival trees, an increased risk of mortality was observed among patients with impaired handgrip and eGFR = 45–59.9 ml/min/1.73 m2, as well as patients with ACR < 30 mg/g and impaired handgrip and SPPB. Survival tree leaf node membership had greater predictive accuracy (C-index = 0.81, 95%CI = 0.78–0.84 for the eGFR survival tree and C-index = 0.77, 95%CI = 0.71–0.81 for the ACR survival tree) in comparison with that of individual measures of kidney function. Conclusions physical performance helps to identify a proportion of patients at an increased risk of mortality despite a mild–moderate impairment in kidney function and improves predictive accuracy of individual measures of kidney function.

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Risks of Changing Estimated Glomerular Filtration Rate Thresholds in Older Persons

Abstract: 2. O'Hare AM, Rodriguez RA, Rule AD. Overdiagnosis of chronic kidney disease in older adults-an inconvenient truth.

Cited by 3 publications

References 8 publications

Biomedical Evaluation of Early Chronic Kidney Disease in the Air Force: Building a Predictive Model from the Taiwan Military Health Service

Biomedical Evaluation of Early Chronic Kidney Disease in the Air Force: Building a Predictive Model from the Taiwan Military Health Service

A focus on CKD reporting and inappropriate prescribing among older patients discharged from geriatric and nephrology units throughout Italy: A nationwide multicenter retrospective cross-sectional study

The relevance of geriatric assessments on the association between chronic kidney disease stages and mortality among older people: a secondary analysis of a multicentre cohort study

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