normal gfr by age and gender

More information regarding this recommendation may be found here. Longitudinal study of living kidney donor glomerular dynamics after nephrectomy. 1978;93(1):626. Barnfield M, Burniston M. Reference data for Tc-99m-DTPA measurements of the GFR derived from live kidney donors. Article MacNaughton J, Banah M, McCloud P, Hee J, Burger H. Age related changes in follicle stimulating hormone, luteinizing hormone, oestradiol and immunoreactive inhibin in women of reproductive age. For Children (Conventional Units) Serum creatinine (mg/dL) Height (cm) Calculate GFR estimate (mL/min/1.73 m) mL/min/1.73 m For Children (SI Units) Serum creatinine (mol/L) The implications of anatomical and functional changes of the aging kidney: with an emphasis on the glomeruli. Measured GFR (mean2 SD) by age and gender in a subgroup of prospective living donors from three centres selected on basis of no proteinuria, normal renal imaging, and normal differential kidney function (N=721). Rowe JW, Andres R, Tobin JD, Norris AH, Shock NW. Fenton, A., Montgomery, E., Nightingale, P. et al. The rationale for these thresholds, which were determined based on our age- and gender-specific GFR reference ranges and previously published evidence, is discussed below. All authors read and approved the final manuscript. This study is to the best of our knowledge the largest published series to date of mGFRs in a healthy population, and we have used it as the basis for new age- and gender-specific reference ranges for GFR and to define advisory mGFR thresholds for living kidney donation that form part of the updated BTS guidelines [8]. Your GFR number will help your healthcare provider know if you have kidney disease. The menopausal transition: analysis of LH, FSH, estradiol, and progesterone concentrations during menstrual cycles of older women. Creatinine test - Mayo Clinic Kidney disease can be found with two simple tests: a urine test for protein (protein is a sign of kidney damage) a blood test for creatinine (used to estimate glomerular filtration rate (gFR) even if these tests are normal now, they should be repeated in the future, especially if you are at increased risk for kidney disease. We also acknowledge the 15 centres who provided data which was amalgamated into this study: Royal Sussex County Hospital, Royal Free Hospital, Kings College Hospital, Addenbrookes Hospital, Glasgow Royal Infirmary, Royal Liverpool University Hospital, St Bartholomews Hospital, St Georges Hospital, Derriford Hospital, Imperial College, London, Manchester Royal Infirmary, Canterbury Hospital, University Hospital, Coventry, St Marys Hospital, St James University Hospital. Normal reference values for glomerular filtration rate: what do we really know? A simple method for the determination of glomerular filtration rate. 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. 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. Current national guidelines recommend that the estimated GFR routinely be reported alongside the creatinine value for adults using the CKD-EPI creatinine-based formula and the updated Schwartz "bedside" formula (CKiD 2009) for children. National Library of Medicine Exception: Using non-indexed eGFR in morbidly obese patients can result in a large overestimate of measured GFR and potential for overdosing. Table S1. British Transplantation Society / Renal Association. AF, EM, PN, MP, NS, CW, and GL participated in the writing of the paper. official website and that any information you provide is encrypted 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). 2014;86(1):1627. 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. A prospective controlled study of living kidney donors: three-year follow-up. 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. PubMed Central Kidney Int. Delanaye P, Glassock RJ, Pottel H, Rule AD. Figure S1. Kidney Int Suppl. Our thresholds, unlike those in the KDIGO guideline, would also allow some older donors with a GFR <60mL/min/1.73m2 to donate. Peters AM, Perry L, Hooker CA, Howard B, Neilly MD, Seshadri N, Sobnack R, Irwin A, Snelling H, Gruning T, et al. 1976;42(4):62936. 1972;30(3):2714. Springer Nature. This may have resulted in a lower estimate of GFR than truly exists in the general population. We have used a large multi-centre series of mGFR data from prospective living kidney donors to produce age- and gender-specific GFR reference ranges which have clinical utility during the assessment of potential living kidney donors and may have implications for the diagnosis of CKD in the general population. 1):4572. To learn more, click, Your support helps families facing kidney, CKD-EPI Creatinine-Cystatin Equation (2021), Pediatric Chronic Kidney Disease Risk Calculator, CKD-EPI creatinine-cystatin equation (2021). The calculator is offered in conventional and SI units. Federal government websites often end in .gov or .mil. AF, EM, PN, MP, NS, CW, and GL participated in the performance of the research. An age-related decline in GFR, which was faster in females, was confirmed in a subgroup of prospective donors selected on the basis of no proteinuria, normal renal imaging, and normal differential kidney function. The incorporation of genetic ancestry data instead of race resulted in similar estimates of the GFR (median difference, 1.33 ml per minute per 1.73 m 2; 95% CI, 0.12 to 2.33; P 10, 42%; 95% CI . The National Kidney Foundation recommends using the CKD-EPI Creatinine Equation (2021) to estimate GFR. Another consequence of using prospective kidney donors was that there were relatively few individuals in the cohort over 70years of age, and this is to be borne in mind when interpreting our GFR reference ranges in this age group. Berg UB. The glomerular filtration rate (GFR) shows how well the kidneys are filtering. Slinin Y, Brasure M, Eidman K, Bydash J, Maripuri S, Carlyle M, Ishani A, Wilt TJ. The upper and lower limits of the reference ranges were defined as two standard deviations (SD) above and below the mean, respectively. This work formed the basis of new recommendations for the assessment of kidney function in the updated British Transplantation Society (BTS) guidelines on living donor kidney transplantation [8]. the contents by NLM or the National Institutes of Health. Table S2. A normal probability plot was used to confirm the validity of the assumption that the residuals were from a Normal distribution. Federal government websites often end in .gov or .mil. The Haycock formula, incorporating height and weight, was used to estimate BSA, and mGFR was scaled to 1.73m2 BSA [11]. Mean mGFR was 100 mL/min/1.73m until 35 years of age, following which there was a linear decline that was faster in females compared to males (7.7 vs 6.6 mL/min/1.73m/decade, P = 0.013); 10.5%. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Correspondence to Solid lines represent mean GFR, and interrupted lines are two standard deviations above and below the mean. 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. Previous studies have suggested that the risk of ESRD after living kidney donation is not higher than in the general population [27, 28], but there is a small absolute increased risk [29,30,31]. we characterize differences in normal GFR based on age, gender, and race, and (3) we describe secular trends of donor demographic and anthropometric changes over a 30-year period and their impact on kidney function. Prospective donors with significant co-morbidity are excluded before the stage of having mGFR and therefore our study population can reasonably be regarded as representative of the healthy population. Your support helps families facing kidney disease at every step of their journey. Males had a higher GFR than females (92.0 vs 88.1mL/min/1.73m2, P<0.0001). In addition, males had a higher initial mGFR which showed a continuous linear decline, unlike females who had a lower initial mGFR that was stable until 35years of age before a linear decline. Furthermore, patients with CKD may progress to end-stage renal disease. An accurate determination of the glomerular filtration rate . There is a need for a large, contemporary, multi-centre series of measured glomerular filtration rates (mGFR) from healthy individuals to determine age- and gender-specific reference ranges for GFR. 2010;17(4):3027. Your US state privacy rights, NS, CW, and GL participated in research design. Individual-level data including pre-donation mGFR from 2974 prospective living kidney donors from 18 UK renal centres performed between 2003 and 2015 were amalgamated. PubMed Bethesda, MD 20894, Web Policies Figure S2. Distribution of measured GFR in apparently healthy Chinese adults. 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. The 'ideal' study to define 'normal' GFR values would be a study with the following characteristics: the sample must be of sufficient size and representative of the general population (according to age, gender and ethnicity), the healthy status of the sample must be unquestionable, the method used to measure GFR must be accurate and the . Google Scholar. Neither the category of GFR nor the category of albuminuria alone can fully capture prognosis of CKD. 2009;75(10):107987. Lenihan CR, Busque S, Derby G, Blouch K, Myers BD, Tan JC. Those with missing data in any of these three variables were also excluded. Another consequence of using prospective kidney donors was that there were relatively few individuals in the cohort over 70years of age, and this is to be borne in mind when interpreting our GFR reference ranges in this age group. . The usual range of Kidney Glomerular Filtration Rate is 100 to 130 mL/min/1.73m2 in men and 90 to 120mL/min/1.73m2 in women below 40. Ann Intern Med. Age-adjusted standards for creatinine clearance. Impact of the derived equation was tested in a second cohort of 7551 patients with normal serum creatinine. Assessment of GFR in prospective kidney donors is an important factor in determining risk and living kidney donation guidelines have provided threshold GFRs above which the increased risk may generally be considered acceptable. 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. All 18 centres adhered to the BNMS guidelines for the measurement of GFR [2]. 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. We identified and collected data for 1096 prospective living kidney donors from our three centres who had undergone mGFR between 2007 and 2015. Figure S2. The https:// ensures that you are connecting to the Rowe JW, Andres R, Tobin JD, Norris AH, Shock NW. FOIA Impact of age on glomerular filtration estimates - PubMed This was a retrospective study using routinely-collected health data. NKF and the American Society of Nephrology have convened a Task Force to focus on the use of race to estimate GFR. Results: While all equations show declining function with age, our results suggest that the GFR reduction is progressive after the age of 30 and continue to decline steadily after the age of 60. Neil Sheerin, Email: ku.ca.eltsacwen@nireehs.lien. Delanaye P, Schaeffner E, Ebert N, Cavalier E, Mariat C, Krzesinski JM, Moranne O. Age and association of kidney measures with mortality and end-stage renal disease. Forty-eight (10.5%) of the 459 individuals aged over 60years had a mGFR <60mL/min/1.73m2. An age-calibrated definition of chronic kidney disease: rationale and benefits. These data from our three centres were then amalgamated with individual-level data from a published study of mGFRs in prospective living kidney donors from 15 other UK renal centres [9] (measured between 2003 and 2010, although the years of measurement varied between centres, and completeness of capture for each centre is not known), producing a dataset of prospective donors from 18 centres with the following variables: age, sex, renal centre, and mGFR per 1.73m2 body surface area (BSA). Measured and estimated GFR in healthy potential kidney donors. 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). 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. JAMA. 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. Cite this article. Kidney disease: improving global outcomes (KDIGO) CKD work group. The study population comprised prospective living kidney donors from UK renal centres who had undergone mGFR as part of their evaluation and were included irrespective of whether or not they proceeded to donation. Received 2018 Apr 16; Accepted 2018 Oct 31. An age-calibrated definition of chronic kidney disease: rationale and benefits. Although most studies have found no significant difference in GFR between males and females, our findings that males have a higher overall GFR and a less rapid decline with age are consistent with the results of several other reports [6, 20,21,22]. Estimation of GFR by creatinine-based equations includes other variables like gender, . A large multi-centre observational cohort study with prospective recruitment of potential living kidney donors, incorporating baseline and longitudinal demographic and bioclinical data with a standardized method for mGFR and other renal phenotyping would be desirable to provide robust data on the effects of age, gender, and ethnicity on GFR. In: Smith HW, editor. Nephron Physiol. We recommended an advisory threshold GFR of >80mL/min/1.73m2 for prospective donors aged 3045, because this appears safe based on long-term outcome studies showing only a very small absolute increased risk of ESRD in cohorts of donors with this level of renal function and in this age range [30, 31]. . 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]. At 70 years of age > 40 ml/min/m2 of GFR will be lost. Glassock RJ, Winearls C. Ageing and the glomerular filtration rate: truths and consequences. In our study population of 2974 prospective donors, these GFR thresholds would lead to the exclusion of an additional 5.0% (19.9% vs 14.8%) of prospective donors compared to the thresholds in the previous BTS living kidney donation guidelines if adhered to rigidly [38]. Second, our estimates of GFR in the general population may be biased by the use of prospective living kidney donors as our study population. Age- and gender-specific GFR reference ranges based on measured GFRs from 2974 prospective living kidney donors. The GFR ranges were used along with other published evidence to provide advisory age- and gender-specific GFR thresholds for living kidney donation. Reference ranges for GFR were created using segmented multiple linear regression incorporating the amalgamated data from all 18 centres to model mGFR as a function of age and gender. Kasiske BL, Anderson-Haag T, Israni AK, Kalil RS, Kimmel PL, Kraus ES, Kumar R, Posselt AA, Pesavento TE, Rabb H, et al. Kidney disease: improving global outcomes (KDIGO) CKD work group. Individuals who have volunteered to donate a kidney and have had a satisfactory initial medical assessment to reach the point of having their GFR measured are likely to be healthier than the unscreened general population, and we would therefore anticipate a higher reference range than in the general population. These findings were also evident in the subgroup of prospective donors with no evidence of kidney pathology. MacNaughton J, Banah M, McCloud P, Hee J, Burger H. Age related changes in follicle stimulating hormone, luteinizing hormone, oestradiol and immunoreactive inhibin in women of reproductive age. 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. GFR, glomerular filtration rate. 2012;27(7):266472. 2017;137(Suppl. Normal GFR varies according to age, sex, and body size; in young adults it is approximately 120 ml/min/1.73 m 2 and declines in normal individuals with age. Soveri I, Berg UB, Bjork J, Elinder CG, Grubb A, Mejare I, Sterner G, Back SE, Group SGR. Google Scholar. A large multi-centre observational cohort study with prospective recruitment of potential living kidney donors, incorporating baseline and longitudinal demographic and bioclinical data with a standardized method for mGFR and other renal phenotyping would be desirable to provide robust data on the effects of age, gender, and ethnicity on GFR. In the absence of evidence of kidney damage, neither GFR category G1 nor G2 fulfill the criteria for CKD. Blake GM, Sibley-Allen C, Hilton R, Burnapp L, Moghul MR, Goldsmith D. Glomerular filtration rate in prospective living kidney donors. Males had a higher GFR than females (92.0 vs 88.1mL/min/1.73m2, P<0.0001). Although most studies have found no significant difference in GFR between males and females, our findings that males have a higher overall GFR and a less rapid decline with age are consistent with the results of several other reports [6, 2022]. 1284 (43.2%) were male, mean age was 46.3years (SD 12.3), and mean mGFR was 89.8mL/min/1.73m2 (SD 15.8). Am J Kidney Dis. Overall, 78 (2.6%) individuals had a mGFR <60mL/min/1.73m2. 2005;101(1):p216. 2. Extracellular fluid volume and glomerular filtration rate in 1878 healthy potential renal transplant donors: effects of age, gender, obesity and scaling. Am J Kidney Dis. 2012;82(3):2707. This GFR decline was faster in females compared to males (7.7 vs 6.6mL/min/1.73m2/decade, P=0.013). Poggio ED, Rule AD, Tanchanco R, Arrigain S, Butler RS, Srinivas T, Stephany BR, Meyer KH, Nurko S, Fatica RA, et al. Ibrahim HN, Foley R, Tan L, Rogers T, Bailey RF, Guo H, Gross CR, Matas AJ. 2006;70(10):180110. All 18 centres adhered to the BNMS guidelines for the measurement of GFR [2]. Estimated Glomerular Filtration Rate (GFR) Test for Your Kidneys - WebMD Ethnic and gender related differences in the risk of end-stage renal disease after living kidney donation. The means and reference ranges for GFR by age and gender are shown in Table1 and Fig. Provided by the Springer Nature SharedIt content-sharing initiative. Peters AM, Perry L, Hooker CA, Howard B, Neilly MD, Seshadri N, Sobnack R, Irwin A, Snelling H, Gruning T, et al. This may have resulted in a lower estimate of GFR than truly exists in the general population. An age-related decline in GFR, which was faster in females, was confirmed in a subgroup of prospective donors selected on the basis of no proteinuria, normal renal imaging, and normal differential kidney function. GFR is the best measure of kidney function, but creatinine can also be a helpful indicator of your kidney health. These ranges, in addition to other published evidence as described below, were used to establish GFR thresholds for prospective living kidney donors, below which kidney donation would not be recommended. 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. Ma YC, Zuo L, Chen L, Su ZM, Meng S, Li JJ, Zhang CL, Wang HY. Aging and decreased glomerular filtration rate: An elderly - PLOS A single-centre cohort of 904 prospective living kidney donors found the decline in mGFR with age was nonlinear, getting steeper with age [5]. Rule AD, Gussak HM, Pond GR, Bergstralh EJ, Stegall MD, Cosio FG, Larson TS. If your eGFR is below 90, your kidneys may not be functioning as well as they should and you may be at risk for .
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