In Reply We respectfully disagree with Dr Rosansky on several key points and favor a more comprehensive approach to the care of older patients with CKD than he has proposed.
First, the current eGFR and the rate of future decline are each important in the care of older patients with CKD. Numerous studies show the current eGFR is related to a broad range of adverse outcomes beyond kidney failure, including cardiovascular disease, metabolic and hormonal complications, medication toxicity, infections, cognitive impairment, and frailty.1
Levey AS, Inker LA, Coresh J. Managing Chronic Kidney Disease in Older People—Reply. JAMA. 2016;315(3):307. doi:10.1001/jama.2015.16002