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Mortality risk stratification in chronic kidney disease: one size for all ages?
J Am Soc Nephrol. 2006 Mar; 17(3):846-53.JA

Abstract

Current National Kidney Foundation Kidney Disease Outcomes Quality Initiative staging criteria for chronic kidney disease (CKD) are intended to apply to all age groups. However, it is unclear whether different levels of estimated GFR (eGFR) have the same prognostic significance in older and younger patients. The study cohort was composed of Department of Veterans Affairs (VA) patients who were aged 18 to 100 yr and had at least one outpatient serum creatinine measurement between October 1, 2001, and September 30, 2002 (n=2583,911). Patients with ESRD were excluded. GFR was estimated using the Modification of Diet in Renal Disease equation using each patient's first outpatient creatinine measurement during the study period. The association of eGFR with survival was measured by age group. Twenty percent of cohort patients had an eGFR<60 ml/min per 1.73 m2, ranging from 3% among 18- to 44-yr-olds to as high as 49% among 85- to 100-yr-olds. Fifty-two percent (n=266,421) of cohort patients with an eGFR<60 ml/min per 1.73 m2 had "very" moderate reductions in eGFR into the 50- to 59-ml/min per 1.73 m2 range. The association of eGFR with mortality was weaker in the elderly than in younger age groups: Whereas severe reductions in eGFR were associated with an increased risk for death in all age groups, "very" moderate reductions in eGFR (50 to 59 ml/min per 1.73 m2) were associated with an increased adjusted risk for death only among patients who were younger than 65 yr. Age-related attenuation of the association of eGFR with mortality was also present among women and black patients. In the clinical setting, mortality risk stratification in elderly patients should not be based on the same eGFR cut points as for younger age groups and would benefit from finer categorization of the 30- to 59-ml/min per 1.73 m2 eGFR group.

Authors+Show Affiliations

Department of Medicine, University of California San Francisco, VA Medical Center, San Francisco, 111J Nephrology, 4150 Clement Street, San Francisco, CA 94121, USA. ann.o'hare@med.va.govNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

16452492

Citation

O'Hare, Ann M., et al. "Mortality Risk Stratification in Chronic Kidney Disease: One Size for All Ages?" Journal of the American Society of Nephrology : JASN, vol. 17, no. 3, 2006, pp. 846-53.
O'Hare AM, Bertenthal D, Covinsky KE, et al. Mortality risk stratification in chronic kidney disease: one size for all ages? J Am Soc Nephrol. 2006;17(3):846-53.
O'Hare, A. M., Bertenthal, D., Covinsky, K. E., Landefeld, C. S., Sen, S., Mehta, K., Steinman, M. A., Borzecki, A., & Walter, L. C. (2006). Mortality risk stratification in chronic kidney disease: one size for all ages? Journal of the American Society of Nephrology : JASN, 17(3), 846-53.
O'Hare AM, et al. Mortality Risk Stratification in Chronic Kidney Disease: One Size for All Ages. J Am Soc Nephrol. 2006;17(3):846-53. PubMed PMID: 16452492.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mortality risk stratification in chronic kidney disease: one size for all ages? AU - O'Hare,Ann M, AU - Bertenthal,Daniel, AU - Covinsky,Kenneth E, AU - Landefeld,C Seth, AU - Sen,Saunak, AU - Mehta,Kala, AU - Steinman,Michael A, AU - Borzecki,Ann, AU - Walter,Louise C, Y1 - 2006/02/01/ PY - 2006/2/3/pubmed PY - 2006/7/28/medline PY - 2006/2/3/entrez SP - 846 EP - 53 JF - Journal of the American Society of Nephrology : JASN JO - J Am Soc Nephrol VL - 17 IS - 3 N2 - Current National Kidney Foundation Kidney Disease Outcomes Quality Initiative staging criteria for chronic kidney disease (CKD) are intended to apply to all age groups. However, it is unclear whether different levels of estimated GFR (eGFR) have the same prognostic significance in older and younger patients. The study cohort was composed of Department of Veterans Affairs (VA) patients who were aged 18 to 100 yr and had at least one outpatient serum creatinine measurement between October 1, 2001, and September 30, 2002 (n=2583,911). Patients with ESRD were excluded. GFR was estimated using the Modification of Diet in Renal Disease equation using each patient's first outpatient creatinine measurement during the study period. The association of eGFR with survival was measured by age group. Twenty percent of cohort patients had an eGFR<60 ml/min per 1.73 m2, ranging from 3% among 18- to 44-yr-olds to as high as 49% among 85- to 100-yr-olds. Fifty-two percent (n=266,421) of cohort patients with an eGFR<60 ml/min per 1.73 m2 had "very" moderate reductions in eGFR into the 50- to 59-ml/min per 1.73 m2 range. The association of eGFR with mortality was weaker in the elderly than in younger age groups: Whereas severe reductions in eGFR were associated with an increased risk for death in all age groups, "very" moderate reductions in eGFR (50 to 59 ml/min per 1.73 m2) were associated with an increased adjusted risk for death only among patients who were younger than 65 yr. Age-related attenuation of the association of eGFR with mortality was also present among women and black patients. In the clinical setting, mortality risk stratification in elderly patients should not be based on the same eGFR cut points as for younger age groups and would benefit from finer categorization of the 30- to 59-ml/min per 1.73 m2 eGFR group. SN - 1046-6673 UR - https://www.unboundmedicine.com/medline/citation/16452492/Mortality_risk_stratification_in_chronic_kidney_disease:_one_size_for_all_ages L2 - https://jasn.asnjournals.org/cgi/pmidlookup?view=long&amp;pmid=16452492 DB - PRIME DP - Unbound Medicine ER -