Importance Using the same level of estimated glomerular filtration rate (eGFR) to define chronic kidney disease (CKD) regardless of patient age may classify many elderly people with a normal physiological age-related eGFR decline as having a disease. Objective To compare the outcomes associated with CKD as defined by a fixed vs an age-adapted eGFR threshold. Design, Setting, and Participants This population-based cohort study was conducted in Alberta, Canada and used linked administrative and laboratory data from adults with incident CKD from April 1, 2009, to March 31, 2017, defined by a sustained reduction in eGFR for longer than 3 months below a fixed or an age-adapted eGFR threshold. Non-CKD controls were defined as being 65 years or older with a sustained eGFR of 60 to 89 mL/min/1.73 m2 for longer than 3 months and normal/mild albuminuria. The follow-up ended on March 31, 2019. The data were analyzed from February to April 2020. Exposures A fixed eGFR threshold of 60 vs thresholds of 75, 60, and 45 mL/min/1.73 m2 for age younger than 40, 40 to 64, and 65 years or older, respectively. Main Outcomes and Measures Competing risks of kidney failure (kidney replacement initiation or sustained eGFR <15 mL/min/1.73 m2 for >3 months) and death without kidney failure. Results The fixed and age-adapted CKD cohorts included 127 132 (69 546 women [54.7%], 57 586 men [45.3%]) and 81 209 adults (44 582 women [54.9%], 36 627 men [45.1%]), respectively (537 vs 343 new cases per 100 000 person-years). The fixed-threshold cohort had lower risks of kidney failure (1.7% vs 3.0% at 5 years) and death (21.9% vs 25.4%) than the age-adapted cohort. A total of 53 906 adults were included in both cohorts. Of the individuals included in the fixed-threshold cohort only (n = 72 703), 54 342 (75%) were 65 years or older and had baseline eGFR of 45 to 59 mL/min/1.73 m2 with normal/mild albuminuria. The 5-year risks of kidney failure and death among these elderly people were similar to those of non-CKD controls, with a risk of kidney failure of 0.12% or less in both groups across all age categories and a risk of death at 69, 122, 279, and 935 times higher than the risk of kidney failure for 65 to 69, 70 to 74, 75 to 79, and 80 years or older, respectively. Conclusions and Relevance This cohort study of adults with CKD suggests that the current criteria for CKD that use the same eGFR threshold for all ages may result in overestimation of the CKD burden in an aging population, overdiagnosis, and unnecessary interventions in many elderly people who have age-related loss of eGFR.

中文翻译：

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在慢性肾病的定义中考虑年龄。

重要性 无论患者年龄如何，使用相同水平的估计肾小球滤过率 (eGFR) 来定义慢性肾脏病 (CKD) 可能会将许多具有正常生理年龄相关性 eGFR 下降的老年人归类为患有疾病。目的比较由固定和年龄适应的 eGFR 阈值定义的 CKD 相关结果。设低于固定或适应年龄的 eGFR 阈值超过 3 个月。非 CKD 对照定义为 65 岁或以上，持续 eGFR 为 60 至 89 mL/min/1.73 m2 超过 3 个月且蛋白尿正常/轻度。随访于 2019 年 3 月 31 日结束。数据分析时间为 2020 年 2 月至 2020 年 4 月。 暴露 40、40 岁以下的固定 eGFR 阈值为 60 与 75、60 和 45 mL/min/1.73 m2 的阈值分别为 64 岁和 65 岁或以上。主要结果和措施 肾衰竭（开始肾置换或持续 eGFR <15 mL/min/1.73 m2 超过 3 个月）和无肾衰竭死亡的竞争风险。结果 固定和年龄适应 CKD 队列包括 127 132 名（69 546 名女性 [54.7%]、57 586 名男性 [45.3%]）和 81 209 名成人（44 582 名女性 [54.9%]、36 627 名男性 [45.1%]） ，分别（每 10 万人年 537 对 343 例新病例）。与年龄适应队列相比，固定阈值队列的肾衰竭风险（1.7% vs 5 年 3.0%）和死亡风险（21.9% vs 25.4%）。两个队列共包括 53 906 名成年人。在仅包含在固定阈值队列中的个体（n = 72 703）中，54 342 人（75%）年龄在 65 岁或以上，基线 eGFR 为 45 至 59 mL/min/1.73 m2，白蛋白尿正常/轻度。这些老年人的 5 年肾衰竭和死亡风险与非 CKD 对照组相似，两组所有年龄组的肾衰竭风险均为 0.12% 或更低，死亡风险为 69 岁，分别比 65 至 69 岁、70 至 74 岁、75 至 79 岁和 80 岁或以上的肾衰竭风险高 122、279 和 935 倍。结