Abstract
BackgroundGiven the age-related decline in glomerular filtration rate (GFR) in healthy individuals, we examined the association of all-cause death or cardiovascular event with the Kidney age - Chronological age Difference (KCD) score, whereby an individual’s kidney age is estimated from their estimated GFR (eGFR) and the age-dependent eGFR decline reported for healthy living potential kidney donors.MethodsWe examined the association between death or cardiovascular event and KCD score, age-dependent stepped eGFR criteria (eGFRstep), and eGFR < 60 ml/min/1.73 m2 (eGFR60) in a community-based high cardiovascular risk cohort of 3837 individuals aged ≥60 (median 70, interquartile range 65, 75) years, followed for a median of 5.6 years.ResultsIn proportional hazards analysis, KCD score ≥ 20 years (KCD20) was associated with increased risk of death or cardiovascular event in unadjusted analysis and after adjustment for age, sex and cardiovascular risk factors. Addition of KCD20, eGFRstep or eGFR60 to a cardiovascular risk factor model did not improve area under the curve for identification of individuals who experienced death or cardiovascular event in receiver operating characteristic curve analysis. However, addition of KCD20 or eGFR60, but not eGFRstep, to a cardiovascular risk factor model improved net reclassification and integrated discrimination. KCD20 identified individuals who experienced death or cardiovascular event with greater sensitivity than eGFRstep for all participants, and with greater sensitivity than eGFR60 for participants aged 60–69 years, with similar sensitivities for men and women.ConclusionsIn this high cardiovascular risk cohort aged ≥60 years, the KCD score provided an age-adapted measure of kidney function that may assist patient education, and KCD20 provided an age-adapted criterion of eGFR-related increased risk of death or cardiovascular event. Further studies that include the full age spectrum are required to examine the optimal KCD score cut point that identifies increased risk of death or cardiovascular event, and kidney events, associated with impaired kidney function, and whether the optimal KCD score cut point is similar for men and women.Trial registrationClinicalTrials.gov NCT00400257, NCT00604006, and NCT01581827.
Highlights
Given the age-related decline in glomerular filtration rate (GFR) in healthy individuals, we examined the association of all-cause death or cardiovascular event with the Kidney age - Chronological age Difference (KCD) score, whereby an individual’s kidney age is estimated from their estimated GFR and the age-dependent eGFR decline reported for healthy living potential kidney donors
Relationship of eGFR to age The relationship between participant age and baseline eGFR is shown in Fig. 1; the regression line for agerelated decline in eGFR according to the meta-analysis for healthy living potential kidney donors reported by Pottel et al [3], and the corresponding regression line for a KCD score of 20 years, are shown
Further studies that include the full age spectrum are required to examine the optimal KCD score cut point that identifies eGFR-related increased risk of death or CV event, and whether the optimal KCD score cut point is similar for men and women
Summary
Given the age-related decline in glomerular filtration rate (GFR) in healthy individuals, we examined the association of all-cause death or cardiovascular event with the Kidney age - Chronological age Difference (KCD) score, whereby an individual’s kidney age is estimated from their estimated GFR (eGFR) and the age-dependent eGFR decline reported for healthy living potential kidney donors. Based on an analysis of all-cause mortality according to categories of eGFR and age in patients with little or no albuminuria [4], Delanaye et al recently proposed age-dependent stepped eGFR criteria for CKD diagnosis, whereby CKD was defined by eGFR < 75 ml/min/1.73 m2 for individuals aged < 40 years, < 60 ml/min/1.73 m2 for individuals aged 40– 65 years, and < 45 ml/min/1.73 m2 for individuals aged >
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