We would like to acknowledge Elsie Lanchbury and Chris Boivin from the Department of Nuclear Medicine, University Hospitals Birmingham NHS Foundation Trust, for their contributions to discussions and help with collecting data. We identified a subgroup of prospective kidney donors from our three centres who had no proteinuria, normal renal imaging, and normal differential kidney function by collecting the following additional data from individual patient records: urine albumin-to-creatinine ratio (ACR) or protein-to-creatinine ratio (PCR), renal CT or MR imaging report, and differential kidney function by DMSA. Males had a higher GFR than females (92.0 vs 88.1mL/min/1.73m2, P<0.0001). Overall, 78 (2.6%) individuals had a mGFR <60mL/min/1.73m2. Of the 1096 prospective donors in our three centres, 220 (20.1%) were excluded as they had missing data in one or more of the three following variables: ACR or PCR, renal imaging report, or DMSA result. Reference data on clearances of inulin and PAH in potential kidney donors. GFR and creatinine are usually measured and reported together. However, we recognise that our study has some limitations. More information regarding this recommendation may be found here. Evidence of kidney pathology was defined as proteinuria (ACR2.5mg/mmol in males or3.5mg/mmol in females, or PCR20mg/mmol), abnormal renal imaging (other than angiomyolipoma, a few simple cysts, or a duplex system), or a>10% difference in differential kidney function on DMSA. Long-term risks for kidney donors. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Graham W. Lipkin, Email: ku.shn.bhu@nikpil.maharg. Level and determinants of kidney function in a south Asian population in Pakistan. Am J Kidney Dis. The change in GFR that we describe with age is the change in mean GFR at population level and does not necessarily describe the expected change in an individuals GFR with ageing. http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. Estimation of GFR by creatinine-based equations includes other variables like gender, . 2017;137(Suppl. Normal reference values for glomerular filtration rate: what do we really know? A meta-analysis which evaluated the interaction of age on the association between creatinine-based eGFR and end-stage renal disease (ESRD) and mortality suggested that a low eGFR is associated with increased risks across all age groups, although the relative mortality risk associated with a reduced eGFR decreased with increasing age [17]. Normal urine contains a variety of proteins, including filtered serum proteins and proteins derived from the kidney and urinary tract. Google Scholar. Guidelines for living donor kidney transplantation. We would like to acknowledge Elsie Lanchbury and Chris Boivin from the Department of Nuclear Medicine, University Hospitals Birmingham NHS Foundation Trust, for their contributions to discussions and help with collecting data. Demographic and clinical characteristics associated with glomerular filtration rates in living kidney donors. Exception: Using non-indexed eGFR in morbidly obese patients can result in a large overestimate of measured GFR and potential for overdosing. Scatter plot of measured GFR by age in 2974 prospective living kidney donors. All prospective donors with mGFR during these years were included, and patient records were used to extract individual age, gender, and mGFR. However, because these studies contained only small numbers of younger donors, and another study showed an increased absolute lifetime risk in younger donors with a GFR <90mL/min/1.73m2 [34], we have recommended an advisory threshold GFR of >90mL/min/1.73m2 for donors younger than 30years of age. Population Mean Estimated GFR Chronic Kidney Disease Stages Soveri I, Berg UB, Bjork J, Elinder CG, Grubb A, Mejare I, Sterner G, Back SE, Group SGR Measuring GFR: a systematic review. After age 40, GFR decreases progressively with age. Age and association of kidney measures with mortality and end-stage renal disease. Based on data showing that age-related GFR decline after donation appears to be slower than in the general population, donors should remain within the healthy reference range up to the age of 80years [27, 35, 37]. Normal GFR varies according to age, sex, and body size, and declines with age. Although a reduced glomerular filtration rate (GFR) in old people has been attributed to physiologic aging, it may be associated with kidney disease or superimposed comorbidities. However, whilst threshold GFRs provide useful guidance to clinicians assessing prospective living kidney donors, individualised decision-making is important, especially in cases where GFR may be just below the recommended advisory threshold, or where there are compounding risk factors for ESRD. These data were amalgamated with individual-level data from 1878 prospective donors from the 15 other UK renal centres, producing a dataset for 2974 prospective donors from 18 centres. Fleming JS, Zivanovic MA, Blake GM, Burniston M, Cosgriff PS, British Nuclear Medicine S. Guidelines for the measurement of glomerular filtration rate using plasma sampling. Age- and gender-specific normal GFR reference ranges based on measured GFRs from 2974 prospective living kidney donors, Age- and gender-specific GFR reference ranges based on measured GFRs from 2974 prospective living kidney donors. 2011;58(5):76472. 1992;36(4):33945. A simple method for the determination of glomerular filtration rate. Of the 1096 prospective donors in our three centres, 220 (20.1%) were excluded as they had missing data in one or more of the three following variables: ACR or PCR, renal imaging report, or DMSA result. Your doctor may ask you not to eat (fast) overnight before the test. Barai S, Bandopadhayaya GP, Patel CD, Rathi M, Kumar R, Bhowmik D, Gambhir S, Singh NG, Malhotra A, Gupta KD. Blake GM, Sibley-Allen C, Hilton R, Burnapp L, Moghul MR, Goldsmith D. Glomerular filtration rate in prospective living kidney donors. Risk of end-stage renal disease following live kidney donation. Kidney-failure risk projection for the living kidney-donor candidate. Berg UB. . Cookies policy. Markers of kidney disease which may be present include: Proteinuria Haematuria (of presumed or proven renal origin) The available data on long-term outcomes is insufficient to know whether a young individual in this category is at an increased lifetime risk of adverse health outcomes. Mean age was 45.7 (SD 12.5) years and 323 (44.8%) were male. I am unable to provide a more specific diagnosis. Those with missing data in any of these three variables were also excluded. Sherman BM, West JH, Korenman SG. Kidney Int Suppl. Article AF, PN, and MP participated in data analysis. We aimed to address this and to use the ranges to provide age- and gender-specific advisory GFR thresholds considered acceptable for living kidney donation. Healthcare providers use estimated glomerular filtration rate (eGFR) to determine if you have kidney disease, and if so, what stage. Forty-eight (10.5%) of the 459 individuals aged over 60years had a mGFR <60mL/min/1.73m2. GFR, glomerular filtration rate. Ibrahim HN, Foley R, Tan L, Rogers T, Bailey RF, Guo H, Gross CR, Matas AJ. The authors declare that they have no competing interests. 2010;31:471. GFR was evaluated from 51 Cr-EDTA plasma clearance using blood samples taken at 3, 4 and 5 hours. The number of plasma samples obtained to calculate mGFR was two in our centres and varied between two to five in the 15 other centres. JAMA. Measured GFR (mean2 SD) by age and gender in a subgroup of prospective living donors from three centres with no proteinuria, normal renal imaging, and normal differential kidney function (N=721). For example, the 2017 KDIGO guideline suggests that a GFR 90mL/min/1.73m2 is acceptable for donation, while a GFR <60mL/min/1.73m2 is not acceptable for donation and a GFR 6089mL/min/1.73m2 may be acceptable depending on other risk factors [33]. Normal reference values for glomerular filtration rate: what do we really know? Google Scholar. Our finding that GFR is approximately 100mL/min/1.73m2 in young adults is consistent with previously published data [3, 5, 12]. Delanaye P, Glassock RJ, Pottel H, Rule AD. A single-centre cohort of 904 prospective living kidney donors found the decline in mGFR with age was nonlinear, getting steeper with age [5]. Measured and estimated GFR in healthy potential kidney donors. ACR 30 mg/g or other markers of kidney damage, Learn more about CKD-EPI Collaboration and estimating GFR at. 2009;360(5):45969. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Our data showing that over 10% of healthy adults over 60years of age have a GFR <60mL/min/1.73m2 could be used to support that position. The tracer used was 51Cr-EDTA in our three centres and in all of the other 15 centres apart from one which used 99mTc-DTPA. Ibrahim HN, Foley R, Tan L, Rogers T, Bailey RF, Guo H, Gross CR, Matas AJ. Age- and gender-specific GFR reference ranges were determined by segmented multiple linear regression and presented as means two standard deviations. Mean mGFR was 100mL/min/1.73m2 until 35years of age, following which there was a linear decline that was faster in females compared to males (7.7 vs 6.6mL/min/1.73m2/decade, P=0.013); 10.5% of individuals aged >60years had a GFR <60mL/min/1.73m2. 2013;3(1):1150. Peer Review reports Background The glomerular filtration rate (GFR) is a standard measure of renal function and can be determined by measuring the clearance of a molecule freely filtered through the glomerulus (measured GFR, mGFR). Delanaye P, Glassock RJ, Pottel H, Rule AD. The site is secure. Delanaye P, Schaeffner E, Ebert N, Cavalier E, Mariat C, Krzesinski JM, Moranne O. The cohort included 459 (15.4%) individuals over 60years of age, 51 (1.7%) individuals over 70years, and 1 (0.0%) individual over the age of 80years. Neither the category of GFR nor the category of albuminuria alone can fully capture prognosis of CKD. Age- and gender-specific mGFR thresholds, considered acceptable for prospective living kidney donors to proceed to nephrectomy, are shown in Table2 and Additional file 1: Figure S2. Over 10% of prospective donors older than 60years had a mGFR <60mL/min/1.73m2, and our model suggests that the lower limit of the normal range for GFR drops to 60mL/min/1.73m2 by the age of 50 and 55years for females and males, respectively, meeting the GFR cut-off in the current definition of chronic kidney disease (CKD) [16]. We also examined whether age and gender are determinants of GFR in a subgroup of individuals selected on the basis of having no evidence of kidney pathology. Kasiske BL, Anderson-Haag T, Israni AK, Kalil RS, Kimmel PL, Kraus ES, Kumar R, Posselt AA, Pesavento TE, Rabb H, et al. AF, EM, PN, MP, NS, CW, and GL participated in the writing of the paper. Overall, 78 (2.6%) individuals had a mGFR <60mL/min/1.73m2. 1. Data from the resultant subgroup of prospective living kidney donors with no evidence of kidney pathology were used to model mGFR as a function of age and gender as above. Comparative physiology of the kidney. In general, a "good" GFR number is above 60, and a "good" creatinine number is below 1.2. The glomerular filtration rate (GFR) shows how well the kidneys are filtering. In: Smith HW, editor. Our thresholds, unlike those in the KDIGO guideline, would also allow some older donors with a GFR <60mL/min/1.73m2 to donate. Continuous variables are expressed as a mean and standard deviation. Mean GFRtwo SDs for the subgroup are shown in Additional file 1: Table S2 and Figure S1. Prospective donors with any evidence of kidney pathology were excluded. NS, CW, and GL participated in research design. Over 10% of prospective donors older than 60years had a mGFR <60mL/min/1.73m2, and our model suggests that the lower limit of the normal range for GFR drops to 60mL/min/1.73m2 by the age of 50 and 55years for females and males, respectively, meeting the GFR cut-off in the current definition of chronic kidney disease (CKD) [16]. The current BNMS guideline quotes a reference range based on a series of mGFRs in 503 healthy subjects published in 1981: mean GFR in young adults was 105mL/min/1.73m2 which declined by 4mL/min/1.73m2 per decade up to 50years of age, and 10mL/min/1.73m2 per decade thereafter [2, 3]. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. It should also be noted that men younger than 55years and women younger than 50years could have a GFR below the lower limit of their reference range but still 60mL/min/1.73m2 and so, in the absence of another marker of renal disease, would be missed by the current definition of CKD. The association between age and nephrosclerosis on renal biopsy among healthy adults. Hallan SI, Matsushita K, Sang Y, Mahmoodi BK, Black C, Ishani A, Kleefstra N, Naimark D, Roderick P, Tonelli M, et al. glomerular filtration rate; eGFR, estimated GFR; CKD-EPI, Chronic . Our age- and gender-specific GFR reference ranges may be useful in the management of an older individual with a GFR <60mL/min/1.73m2: if GFR is within their reference range and there is no other evidence of kidney disease, one may be more confident in attributing a GFR <60mL/min/1.73m2 to normal ageing rather than disease, which may help to avoid unnecessary investigation and over-medicalisation. Figure S1. However, a GFR of 60 or higher is also considered within the normal range if you do not have other signs of kidney disease. Am J Transplant. Continuous variables are expressed as a mean and standard deviation. Kidney disease: improving global outcomes (KDIGO) CKD work group. Haycock GB, Schwartz GJ, Wisotsky DH. BSA did not correlate with age for males or females. The purpose of this study was to use a large, contemporary, multi-centre series of mGFRs from healthy individuals to determine age- and gender-specific reference ranges. Your estimated glomerular filtration rate (eGFR) is the calculation that indicates your level of kidney function, based on the results of a creatinine serum test and other factorssuch as age, gender, muscle mass, and ethnicity. Characteristics of subgroup of prospective living kidney donors from three centres with no proteinuria, normal renal imaging, and normal differential kidney function (N=721). 1976;84(5):5679. For those over 45years, we have recommended advisory GFR thresholds based on calculating the lowest pre-donation GFR that would leave the donor with a post-donation GFR within our age- and gender-specific GFR normal ranges, assuming a 25% loss of GFR [27, 35, 36]. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
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