Kidney Week

Abstract: TH-PO1022

Impact of the CKD-EPI 2021 Equation on the Classification of CKD in Older Australian Adults

Session Information

• CKD: Epidemiology, Risk Factors, and Prevention - 1
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Bongetti, Elisa K., Monash University Department of Medicine, Clayton, Victoria, Australia

Elisa K. Bongetti, MD

• Wolfe, Rory, Monash University, School of Public Health and Preventative Medicine, Melbourne, Victoria, Australia

Rory Wolfe, PhD

• Wetmore, James B., Division of Nephrology, Hennepin Healthcare, Minneapolis, Minnesota, United States

James B. Wetmore, MD, MS

• Murray, Anne M., Berman Center for Outcomes and Clinical Research and Department of Medicine, Hennepin Healthcare Research Institute, and Department of Medicine, Geriatrics Division, Hennepin Healthcare, Minneapolis, Minnesota, United States

Anne M. Murray, MD, MS

• Woods, Robyn L., Monash University, School of Public Health and Preventative Medicine, Melbourne, Victoria, Australia

Robyn L. Woods, PhD

• Fravel, Michelle A., Department of Pharmacy Practice and Science, College of Pharmacy; The University of Iowa, Minneapolis, Minnesota, United States

Michelle A. Fravel

• Nelson, Mark, University of Tasmania Menzies Institute for Medical Research, Hobart, Tasmania, Australia

Mark Nelson, MBBS, PhD

• Stocks, Nigel, Adelaide Medical School, Discipline of General Practice, Adelaide, South Australia, Australia

Nigel Stocks, MD, MBBS

• Orchard, Suzanne G., Monash University, School of Public Health and Preventative Medicine, Melbourne, Victoria, Australia

Suzanne G. Orchard, PhD

• Polkinghorne, Kevan, Department of Nephrology, Monash Health, Melbourne, Victoria, Australia

Kevan Polkinghorne, MBChB, PhD, DrPH

Background

A recalibrated version of CKD-EPI₂₀₀₉, without a race coefficient, was released in 2021 (CKD-EPI₂₀₂₁). This updated equation, implemented in the US, can result in the reclassification of chronic kidney disease (CKD) stage in a significant proportion of individuals. The aim of this study was to investigate the clinical impact of transitioning from the 2009 CKD-EPI (CKD-EPI₂₀₀₉) to the 2021 CKD-EPI (CKD-EPI₂₀₂₁) estimated glomerular filtration rate (eGFR) equation in generally healthy older Australians.

Methods

This was a prospective cohort study using data from 16,244 Australian community-dwelling adults aged ≥70 years, in the ASPirin in Reducing events in the Elderly (ASPREE) study cohort. Baseline characteristics and long-term health outcomes were compared in participants who were reclassified to a different chronic kidney disease (CKD) stage with CKD-EPI₂₀₂₁ versus those with unchanged classification.

Results

With CKD-EPI₂₀₂₁, baseline eGFR increased by a median of 3.8 mL/min/1.73m² (interquartile range [IQR] 3.3, 4.4) resulting in the reclassification of 3,106 (20%) participants to a less advanced CKD stage and the reduction in the prevalence of CKD from 17% to 12%. Over a median follow-up period of 6.5 years (IQR 5.4, 7.9), there was no difference in disability-free survival (HR: 0.94, 95%CI:0.84-1.05), mortality (HR: 0.90, 95%CI:0.78-1.03), major cardiac events (HR: 0.94, 95%CI:0.79-1.13), or hospitalisations for heart failure (HR: 1.00, 95%CI:0.67-1.49) in reclassified, versus non-reclassified, participants.

Conclusion

Implementing CKD-EPI₂₀₂₁ would raise eGFR by a median of nearly 4 ml/min/1.73m², substantially reducing the proportion of older Australian adults classified as having CKD with no difference in long-term health outcomes among reclassified people. Transitioning to using the CKD-EPI₂₀₂₁ may result in a significant reduction in nephrology referrals in generally healthy, older adults.

Funding

• Other NIH Support