Age-Dependent Definition of CKD

I read the online article by Delanaye et al.¹ calling for age-dependent definitions of CKD and the two accompanying editorials^2,3 with great interest. As a pediatric nephrologist, I do not have a stake in the details of the adult argument. However, as a nephrologist, I also recognize the importance of clinically relevant definitions of CKD stages and I was struck by one of the arguments advanced by Chertow and Beddhu² who advise caution before tampering with the current scheme. They take exception to the claim by Delanaye et al. that overdiagnosis of CKD in the elderly could lead to inappropriate care, including diagnostic evaluation and treatment of nonexistent kidney disease. Chertow and Beddhu assert that the elderly are less likely to get clinically indicated care for cardiac disease and other conditions that require contrast-enhanced imaging. In fact, this well documented observation reinforces the call for change by Delanaye et al. because inappropriate care is bidirectional—overzealous evaluation of patients who are healthy and insufficient testing of patients who are presumed sick, in this case with CKD. Rethinking the threshold GFR to define CKD may have the potential to be helpful, not only in the geriatric population but across the life span if that includes the older end of the pediatric spectrum.

Disclosures

None.

Funding

Dr. Trachtman is supported by the National Institute of Diabetes and Digestive and Kidney Diseases (grant DK100307).