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Abstract: PO2333

Gender-Specific Glomerular Filtration Rate Reference Values for Healthy Individuals Aged 18 to 90 Years

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Faucon, Anne-Laure, Centre de recherche en Epidémiologie et Santé des Populations Inserm U1018, Villejuif, France
  • Metzger, Marie, Centre de recherche en Epidémiologie et Santé des Populations Inserm U1018, Villejuif, France
  • Gauci, Cedric, Assistance Publique - Hopitaux de Paris, Paris, Île-de-France, France
  • Houillier, Pascal, Assistance Publique - Hopitaux de Paris, Paris, Île-de-France, France
  • Blanchard, Anne, Assistance Publique - Hopitaux de Paris, Paris, Île-de-France, France
  • Haymann, Jean-Philippe, Assistance Publique - Hopitaux de Paris, Paris, Île-de-France, France
  • Flamant, Martin, Assistance Publique - Hopitaux de Paris, Paris, Île-de-France, France
  • Stengel, Benedicte, Centre de recherche en Epidémiologie et Santé des Populations Inserm U1018, Villejuif, France
  • Froissart, Marc, Centre Hospitalier Universitaire Vaudois, Lausanne, VD, Switzerland
Background

Normal glomerular filtration rate (GFR) values based on a reference method are lacking in the elderly. We measured GFR (mGFR) in healthy individuals 18 to 90 years of age to describe normal mGFR decline with age, by gender, and evaluated the performances of GFR-estimating equations in this population.

Methods

We measured GFR with renal clearance of 51Cr-EDTA in 630 healthy men and women, aged 18-90 years. GAMLSS were used to provide reference values of GFR, and a piecewise linear regression model, to assess the relationship between GFR, age and gender. Bias, precision and accuracy of the CKD-EPI and FAS equations were evaluated.

Results

Participants (43% men) had a mean mGFR of 90.5±15.9 mL/min/1.73m2. The 5th percentile stayed above 60 mL/min/1.73m2 up to 80 years in men, but reached this threshold at age 63 in women, 25% of them getting below at age 76. In both genders, mGFR distribution physiologically declined as from 40 years (Figure), significantly faster in women than in men, 0.83±0.09 vs 0.67±0.07 mL/min/1.73 m2 per year, p<0.001. Overall, median bias was significantly lower for the FAS than the CKD-EPI equation (-1.6 [95%CI: -2.9 ; -0.1] vs 3.4 [1.8 ; 4.9] mL/min/1.73 m2, p < 0.001), whereas precision and P30 accuracy, 6.6 [4.9 ; 8.8] for FAS vs 8.5 [6.6 ; 10.9] for CKD-EPI, did not significantly differ between them. Performance metrics were similar in men and women, but differed across age classes. Above 65 years, CKD-EPI appeared to overestimate and FAS to substantially underestimate mGFR.

Conclusion

Ageing appears to be associated with faster GFR decline in women than in men, which may explain the paradoxical association of high CKD prevalence and low kidney failure incidence in women. Age- and gender-specific reference values should be considered for CKD diagnosis and drug dosing guidelines, particularly in the elderly.

Funding

  • Government Support – Non-U.S.