Classification of chronic kidney disease in older Australian adults by the CKD-EPI 2009 and 2021 equations: secondary analysis of ASPREE study data

Elisa K Bongetti; Rory Wolfe; James B Wetmore; Anne M Murray; Robyn L Woods; Michelle A Fravel; Mark R Nelson; Nigel P Stocks; Suzanne G Orchard; Kevan R Polkinghorne

doi:10.5694/mja2.52559

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Classification of chronic kidney disease in older Australian adults by the CKD-EPI 2009 and 2021 equations: secondary analysis of ASPREE study data

Journal article

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Classification of chronic kidney disease in older Australian adults by the CKD-EPI 2009 and 2021 equations: secondary analysis of ASPREE study data

Elisa K Bongetti, Rory Wolfe, James B Wetmore, Anne M Murray, Robyn L Woods, Michelle A Fravel, Mark R Nelson, Nigel P Stocks, Suzanne G Orchard and Kevan R Polkinghorne

Medical journal of Australia, Vol.222(2), pp.74-81

02/03/2025

DOI: 10.5694/mja2.52559

PMCID: PMC12426956

PMID: 39688123

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Abstract

Objectives To assess the clinical impact on generally healthy older Australians of changing from the 2009 CKD-EPI (CKD-EPI2009) to the 2021 CKD-EPI (CKD-EPI2021) equation for calculating the estimated glomerular filtration rate (eGFR). Study design Secondary analysis of data from the prospective ASPirin in Reducing events in the Elderly (ASPREE) cohort study. Setting, participants Australians aged 70 years or older living in the community and without life-limiting medical conditions, recruited 1 March 2010 – 31 December 2014 for the ASPREE trial. Main outcome measures Baseline characteristics and long term health outcomes for participants classified to different chronic kidney disease (CKD) stages by CKD-EPI2021 and CKD-EPI2009, and for those classified to the same CKD stage by both equations. Results Complete data were available for 16 244 Australian ASPREE trial participants. At baseline, their mean age was 75.3 years (standard deviation, 4.4 years), and 8938 were women (55%); the median eGFR (CKD-EPI2009) was 74 mL/min/1.73 m2 (interquartile range [IQR], 64–85 mL/min/1.73 m2), the median urine albumin-to-creatinine ratio 0.8 mg/mmol (IQR, 0.5–1.4 mg/mmol). eGFR values were higher for most participants with CKD-EPI2021 than with CKD-EPI2009 (median difference, 3.8 mL/min/1.73 m2; IQR, 3.3–4.4 mL/min/1.73 m2), and 3274 participants (20%) were classified to less advanced CKD stages by CKD-EPI2021. The proportion of participants with eGFR values below 60 mL/min/1.73 m2 (clinical CKD) was 17% (2770 participants) with CKD-EPI2009 and 12% (1994 participants) with CKD-EPI2021. Participants were followed up at a median of 6.5 years (IQR, 5.4–7.9 years); the risks of reaching the disability-free survival composite endpoint (adjusted hazard ratio [aHR], 0.94; 95% confidence interval [CI], 0.84–1.05), all-cause mortality (aHR, 0.90; 95% CI, 0.78–1.03), major cardiac events (aHR, 0.94; 95% CI, 0.79–1.13), and hospitalisations with heart failure (aHR, 1.00; 95% CI, 0.67–1.49) were each similar for participants reclassified or not reclassified by CKD-EPI2021. Conclusions Using CKD-EPI2021 would yield higher eGFR values than the CKD-EPI2009, substantially reducing the proportion of older Australian adults classified as having CKD, without any overall difference in long term health outcomes for people reclassified to less advanced CKD stages. Using the CKD-EPI2021 could markedly reduce the number of referrals of generally healthy older adults to specialist nephrology services.

Kidney Diseases

Public Health

Epidemiologic measurements

Renal insufficiency

Diagnostic tests and procedures

Aged

Population health

Details

Title: Subtitle: Classification of chronic kidney disease in older Australian adults by the CKD-EPI 2009 and 2021 equations: secondary analysis of ASPREE study data
Creators: Elisa K Bongetti - Monash University
Rory Wolfe - Monash University
James B Wetmore - Hennepin Healthcare Research Institute
Anne M Murray - Berman Center for Outcomes and Clinical Research
Robyn L Woods - Monash University
Michelle A Fravel - University of Iowa
Mark R Nelson - University of Tasmania
Nigel P Stocks - The University of Adelaide
Suzanne G Orchard - Monash University
Kevan R Polkinghorne - Monash University
Resource Type: Journal article
Publication Details: Medical journal of Australia, Vol.222(2), pp.74-81
DOI: 10.5694/mja2.52559
PMID: 39688123
PMCID: PMC12426956
NLM abbreviation: Med J Aust
ISSN: 0025-729X
eISSN: 1326-5377
Publisher: Wiley
Grant note: U01AG029824 / National Institute on Aging and the National Cancer Institute (National Institutes of Health) 1127060 / National Health and Medical Research Council Monash University 334047 / National Health and Medical Research Council Victorian Cancer Agency
Language: English
Electronic publication date: 12/17/2024
Date published: 02/03/2025
Academic Unit: Pharmacy Practice and Science
Record Identifier: 9984757744902771

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