The average glomerular filtration rate (GFR) is lower in the elderly than in the young and is usually a consequence of biological ageing, the rate of which varies between individuals. In some subjects, the decline is aggravated by concomitant vascular disease. The prevalence of significant kidney disease in the elderly has been overestimated – largely by rendering a diagnosis of chronic kidney disease by reference to estimates of GFR which are found in the young. A stable low GFR in the elderly, provided it is physiologically sufficient to meet homeostatic demands, is not a disease per se and seldom progresses to true kidney failure. However, it can be a risk factor for acute kidney injury drug misdosing, and possibly cardiovascular disease, so it should be noted.

Keywords:
Staging, Ageing, Chronic kidney disease
1.
Hsu CY: Where is the epidemic in kidney disease? J Am Soc Nephrol 2010;21:1607–1611.
2.
Hsu CY, McCulloch CE, Fan D, Ordonez JD, Cherow GM, Go S: Community-based incidence of acute renal failure. Kidney Int 2007;72:208–212.
3.
Byrne C, Ford D, Gilg J, Ansell D, Feehally J: UK ESRD Incident rates in 2008: national and centre-specific analyses. UK Renal Registry 12th Annual Report, 2009. Bristol, UK Renal Registry.
4.
James MT, Hemmelgarn BR, Tonelli M: Early recognition and prevention of chronic kidney disease. Lancet 2010;375:1296–1309.
5.
Moranne O, Froissart M, Rossert J, et al: Timing of onset of CKD-related metabolic complications. J Am Soc Nephrol 2009;20:164–171.
6.
K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002;39:S1–S266.
7.
Rule AD, Amer H, Cornell LD, et al: The association between age and nephrosclerosis on renal biopsy among healthy adults. Ann Intern Med 2010;152:561–567.
8.
Wetzels JF, Kiemeney LA, Swinkels DW, Willems HL, Heijer MD: Age- and gender-specific reference values of estimated GFR in Caucasians: The Nijmegen Biomedical Study. Kidney Int 2007;72:632–637.
9.
Hallan IS, Orth SR: The conundrum of chronic kidney disease classification and end-stage renal risk prediction in the elderly – what is the right approach? Nephron Clin Pract 2010;116:c307–c316.
10.
Tonelli M et al., for the Alberta Kidney Disease Network: Using proteinuria and estimated glomerular filtration rate to classify risk in patients with chronic kidney disease. Ann Intern Med 2011;154:12–21.
11.
Froissart M, Rossert J, Jacquot C, Paillard M, Houillier P: Predictive performance of the modification of diet in renal disease and Cockcroft-Gault equations for estimating renal function. J Am Soc Nephrol 2005;16:763–773.
12.
Tent H, Rook M, Stevens LA, et al: Renal function equations before and after living kidney donation: a within-individual comparison of performance at different levels of renal function. Clin J Am Soc 2010;5:1960–1968.
13.
Stevens LA et al: Comparative performance of the CKD Epidemiology collaboration (CKD EPI) and the Modification of Diet in Renal Disease (MDRD) study equations for estimating GFR levels above 60 ml/min/ 1.73 m2. Am J Kidney Dis 2010;56:486–495.
14.
Ellam TJ, El Nahas M: Proteinuria thresholds are irrational: a call for proteinuria indexing. Nephron Clin Pract 2010;118:c217–c224.
15.
Eriksen BO, Ingebretsen OC: In chronic kidney disease staging the use of chronicity criterion affects prognosis and rate of progression. Kidney Int 2007;72:1242–1248.
16.
Chronic Kidney Disease Prognosis Consortium: Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet 2010;375:2073–2081.
17.
van der Velde M, Bakker SJL, de Jong PE, Gansevoort RT: Influence of age and measure of eGFR on the association between renal function and cardiovascular events. Clin J Am Soc Nephrol 2010;5:2053–2059.
18.
Glassock RJ, Winearls C: Ageing and the glomerular filtration rate: truths and consequences. Trans Am Clin Climatol Assoc 2009;120:419–428.
19.
Clase CM Garg AX, Kibberd BA: Classifying kidney problems: can we avoid framing risks as diseases? Br Med J 2004;329:912– 915.
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2011
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