Cristiano Fabrizio, Musso Carlos Guido
Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d'Annunzio University of Chieti and Pescara, 66100, Chieti, Italy.
ASL 2 Lanciano Vasto Chieti, Nephrology and Dialysis Unit, Ortona Hospital, 66026, Ortona, CH, Italy.
Int Urol Nephrol. 2025 Jul 31. doi: 10.1007/s11255-025-04698-6.
Chronic kidney disease (CKD) is increasingly prevalent among the elderly, yet current diagnostic criteria often fail to distinguish between true CKD and age-related physiological decline in glomerular filtration rate (GFR). This overestimation can lead to overdiagnosis, overtreatment, and psychological distress. Frailty, a common condition in older adults, further complicates the clinical picture. This study aimed to reclassify CKD in the elderly by integrating age-adjusted GFR estimation and frailty assessment in a regional Italian population.
Retrospective, population-based study involving 325,622 individuals aged ≥ 65 years residing in the Abruzzo region. Data included serum creatinine, eGFR (CKD-EPI), urine tests, renal imaging, and frailty measures using the Clinical Frailty Scale (CFS) and Fried Frailty Criteria (FFC). The Keller formula (GFR = 130 - age) was applied to distinguish between physiological renal aging and pathological CKD. Patients were categorized into four groups: Robust CKD, Senescent Nephropathy, Robust Aged Kidney, and Frailty Aged Kidney.
Of the 58,611 elderly patients classified with CKD stages G3-G5 based on CKD-EPI, only 27.9% (65-74 years), 56.0% (75-84 years), and 54.0% (≥ 85 years) had eGFR values below age-adjusted expectations. More than 40% of patients met criteria for renal senescence rather than true CKD. Over 50% of CKD patients fell into frail phenotypes (Senescent Nephropathy or Frailty Aged Kidney), emphasizing the need for a multidimensional clinical approach.
Reclassifying CKD using age-adjusted GFR and frailty assessment improves diagnostic accuracy in the elderly, preventing misdiagnosis and guiding personalized care. This approach supports a shift from static staging to a more nuanced, patient-centered nephrological model that integrates renal physiology and geriatric assessment.
慢性肾脏病（CKD）在老年人中越来越普遍，但目前的诊断标准常常无法区分真正的CKD和与年龄相关的肾小球滤过率（GFR）生理性下降。这种高估可能导致过度诊断、过度治疗和心理困扰。衰弱是老年人的常见状况，这使临床情况更加复杂。本研究旨在通过整合年龄校正的GFR估计和衰弱评估，对意大利一个地区人群中的老年人CKD进行重新分类。
一项基于人群的回顾性研究，纳入了居住在阿布鲁佐地区的325,622名年龄≥65岁的个体。数据包括血清肌酐、估算肾小球滤过率（CKD-EPI）、尿液检查、肾脏影像学检查，以及使用临床衰弱量表（CFS）和弗里德衰弱标准（FFC）进行的衰弱测量。应用凯勒公式（GFR = 130 - 年龄）来区分生理性肾脏衰老和病理性CKD。患者被分为四组：强健型CKD、衰老性肾病、强健型老年肾脏和衰弱型老年肾脏。
在基于CKD-EPI被分类为CKD 3 - 5期的58,611名老年患者中，只有27.9%（65 - 74岁）、56.0%（75 - 84岁）和54.0%（≥85岁）的估算肾小球滤过率值低于年龄校正后的预期值。超过40%的患者符合肾脏衰老标准而非真正的CKD。超过50%的CKD患者属于衰弱表型（衰老性肾病或衰弱型老年肾脏），强调了采用多维临床方法的必要性。
使用年龄校正的GFR和衰弱评估对CKD进行重新分类可提高老年人的诊断准确性，防止误诊并指导个性化护理。这种方法支持从静态分期向更细致、以患者为中心的肾脏病学模式转变，该模式整合了肾脏生理学和老年评估。
