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April 3, 2013

Measures to Define Chronic Kidney Disease—Reply

Stein I. Hallan, MD, PhD; Kunihiro Matsushita, MD, PhD; Josef Coresh, MD, PhD; et al for the Chronic Kidney Disease Prognosis Consortium
Author Affiliations

Letters Section Editor: Jody W. Zylke, MD, Senior Editor.

Author Affiliations: Department of Nephrology, St Olav University Hospital, Trondheim, Norway (Dr Hallan); and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Drs Matsushita and Coresh) (ckdpc@jhmi.edu).

JAMA. 2013;309(13):1343-1344. doi:10.1001/jama.2013.1349

In Reply: The nuances raised by Dr O’Hare are important but they do not invalidate our interpretation that “Although some variation in management of CKD should be considered by age based on cost and benefits, with respect to risk of mortality and ESRD, our data support a common definition and staging of CKD based on eGFR and albuminuria for all age groups.” We agree that no single threshold GFR value for the definition of CKD is perfect. The Chronic Kidney Disease Prognosis Consortium analysis achieved its goal of rigorously evaluating the possible effect modification (interaction) by age of the association of eGFR and albuminuria with clinical risk, examining both relative and absolute risks. Our data demonstrated that eGFR and albuminuria have prognostic significance at all age groups examined, supporting the current uniform thresholds from one aspect.