Abstract :
To the Editor, The conclusions made by Dr. Aimun et al in their recent article entitled “Chronic kidney disease in older people; disease or dilemma?” need to be further expanded. I might, however, start by forwarding a few comments. The choice of 59 mL/min/1.73 m^2 eGFR as a cut-off value that differentiates out age-related from pathological GFR decline may be questioned. The bulk of the patients in the CKD3 stage are elderly patients with, otherwise, no evidence of CKD process. The above assumption about age-related GFR decline has allowed inflating stage 3 and probably 4 by a majority of these individuals. The assumption has ignored the gender-related GFR differences and the effect of advancing age. Based on NHANES 1999- 2004, the US CKD3 population number is 15.5 million (only 0.7 in stage 4), only 24.4% of whom have microalbuminuria. The comparable figure for CKD3 was only 20.4% in a Taiwan study. While the mean ages of the CKD stage 1 and 2 patients in the above Taiwan study were 35.3 (SD 12.3) and 45.3 (SD 14.4) years, respectively, the mean age of CKD3 patients in the same study was 61.9 (SD 11.4) years. The median age of the CKD3 patients in a Norway study was 75.0 years.
