Applicability of current chronic kidney disease criteria for mortality and end-stage kidney disease in older diabetic populations

Since the glomerular filtration rate (GFR) naturally declines with age, age-adjusted chronic kidney disease diagnostic criteria have been proposed. This study aimed to investigate the prognostic impact of estimated GFR (eGFR) on mortality and progression to end-stage kidney disease (ESKD) in normoalbuminuric older adults with type 2 diabetes mellitus. We categorized patients aged ≥65 years without albuminuria who visited our diabetes center by their baseline eGFR levels. Primary outcomes were composite events encompassing all-cause mortality and ESKD. Among 1,997 participants, 8%, 71%, 16%, and 5% had an eGFR of ≥90, 60-89, 45-59, and 15-44 mL/min/1.73 m2, respectively. Adjusted hazard ratios for composite outcomes were 1.30 (95% confidence interval, 1.01-1.76) for those with an eGFR of 45-59 mL/min/1.73 m2, compared to those with an eGFR of 60-90 mL/min/1.73 m2. Subgroup analyses revealed consistently increased risk associated with eGFR 45-59 mL/min/1.73 m2 across individuals with body mass index <25 kg/m2 and those with urine albumin-to-creatinine ratio <10 µg/mgCr. This study indicated that an eGFR of 45-59 mL/min/1.73 m2 possesses an elevated risk of composite events, which suggests that the current traditional eGFR criteria could be applicable to older patients with diabetes mellitus.