eGFR-ACR Risk Stratification of Rapid Kidney Function Decline Across Aging Phenotypes in Older Chinese Adults

Area of Science:

• Nephrology
• Geriatrics
• Public Health

Background:

• Kidney function decline is a significant concern in aging populations.
• Aging phenotypes (healthy, comorbidities, CKD) influence kidney function trajectories.
• Accurate risk stratification is needed for timely intervention.

Purpose of the Study:

• To develop estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (ACR) risk stratification for rapid kidney function decline.
• To analyze risk across different aging phenotypes in older adults.
• To identify phenotype-specific thresholds for targeted interventions.

Main Methods:

• Included 1539 older adults across healthy, comorbidity, and CKD aging phenotypes.
• Defined rapid decline as ≥30% eGFR decrease over 2 years.
• Estimated adjusted incidence rates across eGFR and ACR categories within phenotypes, using random forests to assess variable contribution.

Main Results:

• In healthy aging, moderate risk emerged when eGFR <60 mL/min/1.73 m².
• In comorbidity and CKD cohorts, ACR played a more significant role than eGFR in risk assessment.
• Specific eGFR-ACR combinations were associated with low, moderate, or high risk across phenotypes.

Conclusions:

• Phenotype-specific eGFR-ACR thresholds offer pragmatic risk stratification for older adults.
• These thresholds can guide targeted monitoring and earlier intervention strategies.
• Tailored approaches are essential for managing kidney function decline in diverse aging populations.