Glomerular Filtration Estimating Equations and Clinical Outcomes: What Are We Measuring?

Editorials30 January 2024Glomerular Filtration Estimating Equations and Clinical Outcomes: What Are We Measuring?Georges N. Nakhoul, MD, MEd, Crystal A. Gadegbeku, MDGeorges N. Nakhoul, MD, MEdCleveland Clinic Health System, Department of Kidney Medicine, Cleveland, OhioSearch for more papers by this author, Crystal A. Gadegbeku, MDCleveland Clinic Health System, Department of Kidney Medicine, Cleveland, OhioSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M24-0111 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The development of a standard definition for chronic kidney disease (CKD) and CKD staging has been considered an important advancement that has led to a global awareness of kidney disease that facilitates identification of populations at high risk for kidney and cardiovascular diseases, guides clinical management, informs health care policies, and enhances kidney research (1). In the past 2 decades, CKD classification, endorsed by nephrology guideline organizations, has evolved to include disease etiology, glomerular filtration rate (GFR), and albuminuria to improve its prognostic value (2). Despite widespread adoption of CKD staging by the nephrology community, there have been concerns about ...References1. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39:S1-266. [PMID: 11904577] MedlineGoogle Scholar2. Kidney Disease: Improving Global Outcomes (KDIGO) Chronic Kidney Disease Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013;3:1-150. doi:10.1038/kisup.2012.76 CrossrefGoogle Scholar3. Glassock R, Delanaye P, El Nahas M. An age-calibrated classification of chronic kidney disease. JAMA. 2015;314:559-560. [PMID: 26023760] doi:10.1001/jama.2015.6731 CrossrefMedlineGoogle Scholar4. Denic A, Glassock RJ, Rule AD. Structural and functional changes with the aging kidney. Adv Chronic Kidney Dis. 2016;23:19-28. [PMID: 26709059] doi:10.1053/j.ackd.2015.08.004 CrossrefMedlineGoogle Scholar5. Hallan SI, Matsushita K, Sang Y, et al; Chronic Kidney Disease Prognosis Consortium. Age and association of kidney measures with mortality and end-stage renal disease. JAMA. 2012;308:2349-2360. [PMID: 23111824] doi:10.1001/jama.2012.16817 CrossrefMedlineGoogle Scholar6. Delanaye P, Jager KJ, Bökenkamp A, et al. CKD: a call for an age-adapted definition. J Am Soc Nephrol. 2019;30:1785-1805. [PMID: 31506289] doi:10.1681/ASN.2019030238 CrossrefMedlineGoogle Scholar7. Fu EL, Carrero JJ, Sang Y, et al. Association of low glomerular filtration rate with adverse outcomes at older age in a large population with routinely measured cystatin C. Ann Intern Med. 30 January 2024. [Epub ahead of print]. doi:10.7326/M23-1138 LinkGoogle Scholar8. Inker LA, Eneanya ND, Coresh J, et al; Chronic Kidney Disease Epidemiology Collaboration. New creatinine- and cystatin C-based equations to estimate GFR without race. N Engl J Med. 2021;385:1737-1749. [PMID: 34554658] doi:10.1056/NEJMoa2102953 CrossrefMedlineGoogle Scholar9. Lees JS, Rutherford E, Stevens KI, et al. Assessment of cystatin C level for risk stratification in adults with chronic kidney disease. JAMA Netw Open. 2022;5:e2238300. [PMID: 36282503] doi:10.1001/jamanetworkopen.2022.38300 CrossrefMedlineGoogle Scholar10. Ndumele CE, Rangaswami J, Chow SL, et al; American Heart Association. Cardiovascular-kidney-metabolic health: a presidential advisory from the American Heart Association. Circulation. 2023;148:1606-1635. [PMID: 37807924] doi:10.1161/CIR.0000000000001184 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Georges N. Nakhoul, MD, MEd; Crystal A. Gadegbeku, MDAffiliations: Cleveland Clinic Health System, Department of Kidney Medicine, Cleveland, OhioDisclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M24-0111.Corresponding Author: Crystal A. Gadegbeku, MD, Cleveland Clinic Health System, Department of Kidney Medicine, Medical Specialties Institute, 9500 Euclid Avenue/Q7, Cleveland, OH 44193; e-mail, gadegbc@ccf.org.This article was published at Annals.org on 30 January 2024. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAssociation of Low Glomerular Filtration Rate With Adverse Outcomes at Older Age in a Large Population With Routinely Measured Cystatin C Edouard L. Fu , Juan-Jesus Carrero , Yingying Sang , Marie Evans , Junichi Ishigami , Lesley A. Inker , Morgan E. Grams , Andrew S. Levey , Josef Coresh , and Shoshana H. Ballew Metrics Latest Keywords Acute kidney injury Acute renal failure Cardiovascular diseases Creatinine Cystatin C Estimated glomerular filtration rate Heart failure Hospitalizations Mortality Relative risk ePublished: 30 January 2024 Copyright & PermissionsCopyright © 2024 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...