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Invited Commentary
Less Is More
August 30, 2021

Overdiagnosis of Chronic Kidney Disease in Older Adults—An Inconvenient Truth

Author Affiliations
  • 1Department of Medicine, University of Washington, Seattle
  • 2Hospital and Specialty Medicine, VA Puget Sound Health Care System, Seattle, Washington
  • 3Department of Medicine, Mayo Clinic, Rochester, Minnesota
JAMA Intern Med. 2021;181(10):1366-1368. doi:10.1001/jamainternmed.2021.4823

Overdiagnosis occurs when individuals are diagnosed with conditions that will never cause symptoms or death.

Welch et al, Overdiagnosed: Making People Sick in the Pursuit of Health1

Since its publication in 2002, the National Kidney Foundation (NKF)’s clinical practice guideline2 on the evaluation, classification, and stratification of chronic kidney disease (CKD) dramatically altered how we think about kidney disease and how we care for people with this condition. Almost 2 decades later, many of the practices recommended in this guideline have been fully integrated into clinical practice, such as using a prediction equation to estimate glomerular filtration rate (eGFR) rather than serum creatinine alone, an eGFR-based classification system to define and gage the severity of CKD, and a risk-based approach to managing CKD based on the level of eGFR and albuminuria. The 2002 guideline was in many ways a breath of fresh air. It offered a formal case definition where none had existed previously, a common language to describe the presence and severity of CKD, and a powerful organizing structure to guide clinical care, scientific research, and patient advocacy. Nonetheless, these sweeping changes to the recommended conceptual and pragmatic approach to defining and managing CKD had some unanticipated and unintended adverse consequences. In this issue of JAMA Internal Medicine, Liu et al3 spotlight one of these.

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