High Prevalence of Stage 3 Chronic Kidney Disease in Older Adults Despite Normal Serum Creatinine
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Serum creatinine is commonly used to diagnose chronic kidney disease (CKD), but may underestimate CKD in older adults when compared with using glomerular filtration rates (eGFR). The magnitude of this underestimation is not clearly defined.
Using the Modification of Diet in Renal Disease (MDRD) equation, to describe both the prevalence and the magnitude of underestimation of stage 3 CKD (GFR 30–59 ml/min/1.73 m2), as well as ideal serum creatinine cutoff values to diagnose stage 3 CKD among Americans ≥65 years of age.
A total of 3,406 participants ≥65 years of age from the 1999–2004 National Health and Nutrition Examination Surveys (NHANES).
Serum creatinine levels were used to determine eGFR from the MDRD equation. Information on clinical conditions was self-reported.
Overall, 36.1% of older adults in the US have stage 3 or greater CKD as defined by eGFR values. Among older adults with stage 3 CKD, 80.6% had creatinine values ≤1.5 mg/dl, and 38.6% had creatinine values ≤1.2 mg/dl. Optimal cutoff values for serum creatinine in the diagnosis of stage 3 CKD in older adults were ≥1.3 mg/dl for men and ≥1.0 mg/dl for women, regardless of the presence or absence of hypertension, diabetes, or congestive heart failure.
Use of serum creatinine underestimates the presence of advanced (stage 3 or greater) CKD among older adults in the US. Automated eGFR reporting may improve the accuracy of risk stratification for older adults with CKD.
KEY WORDSchronic kidney disease serum creatinine older adults glomerular filtration rate
This publication was made possible by grant no. U54RR019234 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH). Dr. Duru received support from the UCLA Center for the Health Improvement of Minority Elders/Resource Center for Minority Aging Research, NIH/National Institute on Aging, under grant AG02004. Dr. Vargas was supported by NIH grants RR019234 and MD00148; Ms. Kermah was supported by NIH grants RR03026, RR011145, and RR014616; Dr. Norris received support from NIH grants RR011145, RR014616, RR019234, P30AG21684 and MD000182.
Drs. Norris, Nissenson and Vargas obtained funding to support this study. Drs. Duru and Norris conceived and designed the study, and Dr. Duru drafted the manuscript. Ms. Kermah conducted data analyses. All authors reviewed the manuscript critically for revision of intellectual content.
Dr. Duru had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Funding agencies were not directly involved in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, and approval of the manuscript.
Conflict of Interest
None of the study authors have any conflicts with for-profit companies that relate directly to this manuscript.
Dr. Nissenson has served as a consultant for Amgen, OBI, Roche, Affymax, Medgenics, Fibrogen, Prometic, Advanced Magnetics, Watson and DaVita, as well as received honoraria from Amgen, Roche and Watson. Over the past 3 years, Dr. Nissenson has also received grants from Amgen, OBI, and Roche. He owns stock in Advanced Magnetics.
Dr. Norris has served as a consultant for Abbott, Amgen, Merck and King-Monarch, received honoraria from Abbott, Amgen and Merck, and received grants from Abbott, Pfizer and King-Monarch.
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