Current CKD definitions that do not consider age-related eGFR decline may inflate the burden of CKD in the elderly, according to a study published in JAMA Internal Medicine. Researchers compared the outcomes associated with CKD defined by a fixed eGFR threshold of 60 mL/min/1.73 m² versus thresholds of 75, 60, and 45 mL/min/1.73 m² for age younger than 40, 40-64, and 65 and older, respectively. The fixed-threshold cohort had lower risks for kidney failure (1.7% vs 3.0% at 5 years) and death (21.9% vs 25.4%) compared with the age-adapted cohort. Among 54,342 people aged 65 and older with baseline eGFR of 45-59 mL/min/ 1.73 m² and normal/mild albuminuria who were in the fixed-threshold cohort only, 5-year risks for kidney failure and death were similar to those of non-CKD controls, with a risk for kidney failure of 0.12% or less in both groups across all age categories.
Removing Race Term from CKD-EPI Could Jeopardize Black Patients
Removing race from the Chronic Kidney Disease-Epidemiology Collaboration (CKDEPI) equation will calculate a lower eGFR for Black patients and exclude more from receiving chemotherapy, according to a study published in The Lancet Oncology. Investigators used the CKD-EPI equation and a version of the CKDEPI without the race term (CKD-EPIwithout race) to calculate eGFR based on creatinine (eGFRcr). The Cockcroft-Gault equation was used to calculate estimated creatinine clearance (eClcr). For 10 anticancer drugs, dosing simulations based on each assessment of kidney function were conducted. Thhe median eGFRcr measures were 103 mL/min and 89 mL/min calculated by CKD-EPI and CKD-EPIwithout race, respectively, and the eClcr was 90 mL/min by Cockcroft-Gault. Compared with the CKD-EPI, the number of patients ineligible for therapy or recommended to receive any renal dose adjustment was increased when CKD-EPIwithout race was used but was at a similar rate when CockcroftGault was used. Using CKD-EPIwithout race versus CKD-EPI, up to 18% of patients had discordant recommendations.