Comparison of the profiles of patients defined by age-adapted and fixed threshold CKD criteria: a nationwide, cross-sectional study

Yixin Ma; Jianfeng Lin; Peng Xia; Hua Zheng; Xinqi Cheng; Peili Ji; Wei Wu; Lian Hou; Li Wang; Guangjin Zhu; Ling Qiu; Yali Zheng; Limeng Chen

doi:10.1093/ckj/sfac188

Comparison of the profiles of patients defined by age-adapted and fixed threshold CKD criteria: a nationwide, cross-sectional study

Clin Kidney J. 2022 Aug 25;15(12):2312-2321. doi: 10.1093/ckj/sfac188. eCollection 2022 Dec.

Authors

Yixin Ma^{1

2}, Jianfeng Lin^{1

2}, Peng Xia^{1

2}, Hua Zheng^{3

2}, Xinqi Cheng⁴, Peili Ji^{1

2}, Wei Wu⁴, Lian Hou⁴, Li Wang⁵, Guangjin Zhu⁶, Ling Qiu^{4

2}, Yali Zheng⁷, Limeng Chen^{1

2}

Affiliations

¹ Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
² State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
³ Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
⁴ Department of Laboratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
⁵ Department of Epidemiology and Biostatistics, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
⁶ Department of Pathophysiology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
⁷ Department of Nephrology, Affiliated Ningxia People's Hospital of Ningxia Medical University, Yinchuan, China.

Abstract

Background: Kidney function declines naturally with advancing age. Therefore an age-adapted estimated glomerular filtration rate (eGFR) threshold has been proposed instead of the fixed threshold for CKD definition. This study aims to describe and compare the profile of CKD patients defined by these two criteria in a Chinese population.

Method: We recruited adult participants with selected biochemical tests from the Chinese Physiological Constant and Health Condition survey conducted from 2007 to 2011, with the GFR estimated by the Chronic Kidney Disease Epidemiology Collaboration formula. The age-adapted threshold of eGFR is 75, 60 and 45 ml/min/1.73 m² for the population <40 years of age, 40-64 years and >64 years, respectively. The fixed threshold is 60 ml/min/1.73 m² for all ages.

Results: Among the recruited 23 438 participants, 480 were diagnosed with CKD by fixed threshold criteria, while 391 were diagnosed with CKD by age-adapted criteria. Patients diagnosed by fixed threshold criteria were significantly older (66.4 versus 43.4 years; P < .001) and had a higher prevalence of all CVD risk factors compared with the non-CKD population. In contrast, age-adapted criteria defined a younger patient group and were not significantly associated with diabetes or obesity. When adjusted by age and gender, fixed threshold-defined CKD was not significantly associated with the number of coexisting CVD risk factors, while age-adapted-defined CKD was significantly associated. We also found that the CKD patients defined by age-adapted criteria matched well with the 2.5th percentile of eGFR in Chinese individuals. When compared with their age- and gender-matched controls, patients included by age-adapted criteria but excluded by fixed threshold criteria had a significantly higher prevalence of hypertension (23.2% versus 7.7%; P < .001) and hyperuricaemia (25.0% versus 5.5%; P < .001), while patients included only by the fixed threshold criteria were not significantly different in the prevalence of CVD risk factors and CKD-related disturbance except for hyperuricaemia (41.2% versus 14.0%; P < .001).

Conclusion: An age-adapted criterion is more closely associated with CVD risk factors and CKD-related diseases compared with fixed threshold criteria.

Keywords: CKD; CKD-EPI equation; elderly; hypertension; hyperuricaemia.