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August 11, 2015

An Age-Calibrated Classification of Chronic Kidney Disease

Author Affiliations
  • 1Geffen School of Medicine, University of California-Los Angeles, Laguna Niguel, California
  • 2Department of Nephrology, Dialysis, and Transplantation, University of Liege, Liege, Belgium
  • 3Sheffield Kidney Institute, Global Kidney Academy, Sheffield, England
JAMA. 2015;314(6):559-560. doi:10.1001/jama.2015.6731

Should current guidelines be changed to require age calibration for diagnosis and classification of chronic kidney disease? —Yes.

The classifications of chronic kidney disease (CKD) used both for epidemiological studies in populations and for diagnosis in individual patients have evolved since the original Kidney Disease Quality Outcome Initiative iteration published more than one decade ago. The categorization of CKD, using glomerular filtration rate (GFR) and proteinuria (albuminuria), has undoubtedly raised the profile of CKD among physicians and the general public. However, concern has arisen that this approach incorrectly labels individuals, particularly older persons, as having CKD, thus inflating the prevalence of a generic CKD in the aging population. A paradox arises in that a steadily increasing frequency of such alleged CKD is accompanied by an unchanged or decreasing incidence of treated end-stage renal disease (ESRD), at least in developed nations.1,2