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. 2025 Nov 26;40(12):2326-2337.
doi: 10.1093/ndt/gfaf112.

Prevalence of reduced eGFR in European adults using KDIGO and age-adapted eGFR thresholds

Megan E Astley  1   2 , Nicholas C Chesnaye  1   3 , Giovanni Gambaro  4 , Alberto Ortiz  5 , Stein Hallan  6   7 , Juan-Jesus Carrero  8   9 , Natalie Ebert  10 , Bjørn Odvar Eriksen  11   12 , Anne-Laure Faucon  8 , Pietro Manuel Ferraro  4 , Till Ittermann  13 , Arnar J Jonsson  14   15 , Knut Asbjørn Rise Langlo  6   7 , Toralf Melsom  11   12 , Elke Schaeffner  10 , Sylvia Stracke  16 , Runolfur Palsson  15   17 , Kitty J Jager  1   3 , Vianda S Stel  1   3
Affiliations

Prevalence of reduced eGFR in European adults using KDIGO and age-adapted eGFR thresholds

Megan E Astley et al. Nephrol Dial Transplant. .

Abstract

Background: The current definition for chronic kidney disease (CKD) does not account for age-related kidney function decline. Age-adapted CKD definitions have been suggested, but their impact on the estimates of reduced kidney function prevalence remains unclear. We aimed to compare the prevalence of reduced estimated glomerular filtration rate (eGFR) in European adults using the KDIGO eGFR threshold and three age-adapted eGFR thresholds.

Methods: This cross-sectional study included data collected after 1999 from nine general population-based studies from seven European countries. eGFR was calculated using the European Kidney Function Consortium equation. Prevalence of reduced eGFR was estimated over age using four eGFR thresholds: the KDIGO eGFR threshold (eGFR <60 mL/min/1.73 m2), the categorical age-adapted eGFR threshold (eGFR <75 mL/min/1.73 m2 if aged <40 years, eGFR <60 mL/min/1.73 m2 if aged 40-65 years, eGFR <45 mL/min/1.73 m2 if aged >65 years), and two novel continuous age- and sex-adapted eGFR thresholds based on the 5th and 2.5th percentile of eGFR in healthy individuals.

Results: We used data from over 2.5 million European adults (46% men). Among those under 40 years, the KDIGO threshold provided the lowest average prevalence estimate (<1%), followed by the categorical age-adapted threshold (3%) and the 2.5th and 5th continuous age- and sex-adapted thresholds (4% and 7%). In adults over 65 years, the 2.5th continuous age- and sex-adapted threshold (10%) estimated the lowest prevalence, followed by the 5th continuous age- and sex-adapted threshold (15%), categorical age-adapted threshold (19%) and KDIGO threshold (45%).

Conclusion: Using age-adapted eGFR thresholds would likely cause a shift in the prevalence of reduced kidney function. However, the association between these novel age-adapted thresholds and clinical outcomes needs to be established before considering their incorporation into the definition of CKD.

Keywords: KDIGO; age-adapted; chronic kidney disease; eGFR; prevalence.

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Conflict of interest statement

A.O. has received grants from Sanofi and consultancy or speaker fees or travel support from Advicenne, Alexion, Astellas, AstraZeneca, Amicus, Amgen, Bioporto, Boehringer Ingelheim, Esteve, Fresenius Medical Care, GSK, Bayer, Sanofi-Genzyme, Sobi, Menarini, Mundipharma, Kyowa Kirin, Lilly, Freeline, Idorsia, Chiesi, Otsuka, Novo-Nordisk, Sysmex, and Vifor Fresenius Medical Care Renal Pharma and Spafarma, and is Director of the Catedra UAM-Astrazeneca of chronic kidney disease and electrolytes. He has stock in Telara Farma. E.S. receives honoraria from the National Kidney Foundation, AstraZeneca and Amgen. G.G. has received research grants from Roche Diagnostics, Fresenius Kabi and Alexion, and consultancy or speaker fees from Alexion, Alnylam, Astra Zeneca, Medtronics, Vifor Pharma and Roche Diagnostics, and royalties as an author for UpToDate. J.-J.C. reports grants paid to Karolinska Institutet from AstraZeneca, Boehringer Ingelheim, CSL Vifor, MSD, Astellas and NovoNordisk, all outside the submitted work, and personal fees for lectures or advisory board meetings from Fresenius Kabi and Laboratorios Columbia, all outside the submitted work. N.E. received honoraria from Bayer AG Leverkusen. P.M.F. received consultant fees and grant/other support from Allena Pharmaceuticals, Alnylam, Amgen, AstraZeneca, Bayer, Boehringer, Gilead, Novo Nordisk, Otsuka Pharmaceuticals, Rocchetta, Stada EG and Vifor Fresenius, and royalties as an author for UpToDate.

Figures

Graphical Abstract
Graphical Abstract
Figure 1:
Figure 1:
Four eGFR thresholds used to identify individuals with reduced eGFR based on eGFR calculated by the EKFC equation. The eGFR thresholds presented are the KDIGO eGFR threshold [1], the categorical age-adapted eGFR threshold [3], the 5th continuous age- and sex-adapted eGFR, and the 2.5th continuous age- and sex-adapted eGFR threshold; the latter two are presented in men and women separately. For sex-specific thresholds, the colour is used to represent the threshold and line type is used to represent sex (dashed line for women, solid line for men).
Figure 2:
Figure 2:
Flowchart showing the inclusion process for individuals in the study population. Individuals with missing data on age, sex or serum creatinine were excluded. Those older than 96 years were excluded to align with the maximum age of individuals in the development cohort of the EKFC equation [21].
Figure 3:
Figure 3:
Prevalence of reduced eGFR in individuals aged 18–96 years using four eGFR thresholds (A) to define reduced eGFR, stratified by sex. eGFR was calculated using the EKFC equation (B). Because the KDIGO and categorical age-adapted eGFR thresholds are the same from the ages of 40–65 years, the lines for this age range are overlapping and this is represented by the dashed purple line overlapping the solid green line. (A) The four thresholds are: the KDIGO eGFR threshold (eGFR <60 mL/min/1.73 m2), the categorical age-adapted eGFR threshold (eGFR <75 mL/min/1.73 m2 for those aged below 40 years, eGFR <60 mL/min/1.73 m2 for those aged 40–65 years, eGFR <45 mL/min/1.73 m2 for those aged above 65 years), the 5th continuous age- and sex-adapted eGFR threshold (5th percentile of eGFR from a healthy population), and the 2.5th continuous age- and sex-adapted eGFR threshold (2.5th percentile of eGFR from a healthy population). (B) The EKFC equation.
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