ArticleInternational urology and nephrology2026
Reclassification of chronic kidney disease in the elderly: integrating age-adjusted GFR and frailty assessment in a regional Italian population (Abruzzo).
Article in International urology and nephrology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed.
- "One Size Does Not Fit All" is only the beginning: the need for proportional, patient-level decisions in elderly CKD.International urology and nephrology · 2026Article
- Kidney function in older adults: from eGFR to a phenotype- and frailty-informed approach.International urology and nephrology · 2026Article
- Frailty and chronic kidney disease: beyond risk prediction toward frailty-informed CKD classification.International urology and nephrology · 2026Article
- Keller/eGFR ratio as a simple and useful tool to make a first differentiation between renal aging and chronic nephropathy in large populations.International urology and nephrology · 2026Review
- Renal Dose Adjustment in European Primary Care: Clinical Nuances and Practical Challenges.Journal of clinical medicine · 2026Article
- Prediction is not decision: why frailty must guide clinical choices in hemodialysis.International urology and nephrology · 2026Article
- Serum Osteoprotegerin Level Is Not a Localizing Biomarker of Atherosclerosis Affected by Kidney Function.Diagnostics (Basel, Switzerland) · 2026Article
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Abstract
backgroundChronic kidney disease (CKD) is increasingly prevalent among the elderly, yet current diagnostic criteria often fail to distinguish between true CKD and age-related physiological decline in glomerular filtration rate (GFR). This overestimation can lead to overdiagnosis, overtreatment, and psychological distress. Frailty, a common condition in older adults, further complicates the clinical picture. This study aimed to reclassify CKD in the elderly by integrating age-adjusted GFR estimation and frailty assessment in a regional Italian population.
methodsRetrospective, population-based study involving 325,622 individuals aged ≥ 65 years residing in the Abruzzo region. Data included serum creatinine, eGFR (CKD-EPI), urine tests, renal imaging, and frailty measures using the Clinical Frailty Scale (CFS) and Fried Frailty Criteria (FFC). The Keller formula (GFR = 130 - age) was applied to distinguish between physiological renal aging and pathological CKD. Patients were categorized into four groups: Robust CKD, Senescent Nephropathy, Robust Aged Kidney, and Frailty Aged Kidney.
resultsOf the 58,611 elderly patients classified with CKD stages G3-G5 based on CKD-EPI, only 27.9% (65-74 years), 56.0% (75-84 years), and 54.0% (≥ 85 years) had eGFR values below age-adjusted expectations. More than 40% of patients met criteria for renal senescence rather than true CKD. Over 50% of CKD patients fell into frail phenotypes (Senescent Nephropathy or Frailty Aged Kidney), emphasizing the need for a multidimensional clinical approach.
conclusionsReclassifying CKD using age-adjusted GFR and frailty assessment improves diagnostic accuracy in the elderly, preventing misdiagnosis and guiding personalized care. This approach supports a shift from static staging to a more nuanced, patient-centered nephrological model that integrates renal physiology and geriatric assessment.
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