{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T15:06:10Z","timestamp":1777043170145,"version":"3.51.4"},"reference-count":29,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2024,12,17]],"date-time":"2024-12-17T00:00:00Z","timestamp":1734393600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["U01AG029824"],"award-info":[{"award-number":["U01AG029824"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["334047"],"award-info":[{"award-number":["334047"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["1127060"],"award-info":[{"award-number":["1127060"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001779","name":"Monash University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001779","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008018","name":"Victorian Cancer Agency","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008018","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Medical Journal of Australia"],"published-print":{"date-parts":[[2025,2,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To assess the clinical impact on generally healthy older Australians of changing from the 2009 CKD\u2010EPI (CKD\u2010EPI<jats:sub>2009<\/jats:sub>) to the 2021 CKD\u2010EPI (CKD\u2010EPI<jats:sub>2021<\/jats:sub>) equation for calculating the estimated glomerular filtration rate (eGFR).<\/jats:p><\/jats:sec><jats:sec><jats:title>Study design<\/jats:title><jats:p>Secondary analysis of data from the prospective ASPirin in Reducing events in the Elderly (ASPREE) cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting, participants<\/jats:title><jats:p>Australians aged 70 years or older living in the community and without life\u2010limiting medical conditions, recruited 1 March 2010 \u2013 31 December 2014 for the ASPREE trial.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Baseline characteristics and long term health outcomes for participants classified to different chronic kidney disease (CKD) stages by CKD\u2010EPI<jats:sub>2021<\/jats:sub> and CKD\u2010EPI<jats:sub>2009<\/jats:sub>, and for those classified to the same CKD stage by both equations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Complete data were available for 16\u2009244 Australian ASPREE trial participants. At baseline, their mean age was 75.3 years (standard deviation, 4.4 years), and 8938 were women (55%); the median eGFR (CKD\u2010EPI<jats:sub>2009<\/jats:sub>) was 74\u2009mL\/min\/1.73\u2009m<jats:sup>2<\/jats:sup> (interquartile range [IQR], 64\u201385\u2009mL\/min\/1.73\u2009m<jats:sup>2<\/jats:sup>), the median urine albumin\u2010to\u2010creatinine ratio 0.8\u2009mg\/mmol (IQR, 0.5\u20131.4\u2009mg\/mmol). eGFR values were higher for most participants with CKD\u2010EPI<jats:sub>2021<\/jats:sub> than with CKD\u2010EPI<jats:sub>2009<\/jats:sub> (median difference, 3.8\u2009mL\/min\/1.73\u2009m<jats:sup>2<\/jats:sup>; IQR, 3.3\u20134.4\u2009mL\/min\/1.73\u2009m<jats:sup>2<\/jats:sup>), and 3274 participants (20%) were classified to less advanced CKD stages by CKD\u2010EPI<jats:sub>2021<\/jats:sub>. The proportion of participants with eGFR values below 60\u2009mL\/min\/1.73\u2009m<jats:sup>2<\/jats:sup> (clinical CKD) was 17% (2770 participants) with CKD\u2010EPI<jats:sub>2009<\/jats:sub> and 12% (1994 participants) with CKD\u2010EPI<jats:sub>2021<\/jats:sub>. Participants were followed up at a median of 6.5 years (IQR, 5.4\u20137.9 years); the risks of reaching the disability\u2010free survival composite endpoint (adjusted hazard ratio [aHR], 0.94; 95% confidence interval [CI], 0.84\u20131.05), all\u2010cause mortality (aHR, 0.90; 95% CI, 0.78\u20131.03), major cardiac events (aHR, 0.94; 95% CI, 0.79\u20131.13), and hospitalisations with heart failure (aHR, 1.00; 95% CI, 0.67\u20131.49) were each similar for participants reclassified or not reclassified by CKD\u2010EPI<jats:sub>2021<\/jats:sub>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Using CKD\u2010EPI<jats:sub>2021<\/jats:sub> would yield higher eGFR values than the CKD\u2010EPI<jats:sub>2009<\/jats:sub>, substantially reducing the proportion of older Australian adults classified as having CKD, without any overall difference in long term health outcomes for people reclassified to less advanced CKD stages. Using the CKD\u2010EPI<jats:sub>2021<\/jats:sub> could markedly reduce the number of referrals of generally healthy older adults to specialist nephrology services.<\/jats:p><\/jats:sec>","DOI":"10.5694\/mja2.52559","type":"journal-article","created":{"date-parts":[[2024,12,17]],"date-time":"2024-12-17T11:04:26Z","timestamp":1734433466000},"page":"74-81","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Classification of chronic kidney disease in older Australian adults by the <scp>CKD<\/scp>\u2010<scp>EPI<\/scp> 2009 and 2021 equations: secondary analysis of <scp>ASPREE<\/scp> study data"],"prefix":"10.5694","volume":"222","author":[{"given":"Elisa K","family":"Bongetti","sequence":"first","affiliation":[{"name":"Monash Medical Centre  Melbourne VIC"},{"name":"Monash University  Melbourne VIC"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rory","family":"Wolfe","sequence":"additional","affiliation":[{"name":"Monash University  Melbourne VIC"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James B","family":"Wetmore","sequence":"additional","affiliation":[{"name":"Hennepin Healthcare  Minneapolis MN United States of America"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anne M","family":"Murray","sequence":"additional","affiliation":[{"name":"Berman Center for Outcomes and Clinical Research, Hennepin Healthcare Research Institute  Minneapolis MN United States of America"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robyn L","family":"Woods","sequence":"additional","affiliation":[{"name":"Monash University  Melbourne VIC"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelle A","family":"Fravel","sequence":"additional","affiliation":[{"name":"Carver College of Medicine the University of Iowa  Iowa City IA United States of America"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark R","family":"Nelson","sequence":"additional","affiliation":[{"name":"Menzies Institute for Medical Research University of Tasmania  Hobart TAS"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nigel P","family":"Stocks","sequence":"additional","affiliation":[{"name":"The University of Adelaide  Adelaide SA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suzanne G","family":"Orchard","sequence":"additional","affiliation":[{"name":"Monash University  Melbourne VIC"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevan R","family":"Polkinghorne","sequence":"additional","affiliation":[{"name":"Monash Medical Centre  Melbourne VIC"},{"name":"Monash University  Melbourne VIC"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,12,17]]},"reference":[{"key":"e_1_2_8_1_1","first-page":"CD007333","article-title":"Early referral to specialist nephrology services for preventing the progression to end\u2010stage kidney disease","volume":"18","author":"Smart NA","year":"2014","journal-title":"Cochrane Database of Syst Rev"},{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40266-018-0563-1"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2102953"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/clinchem\/hvab278"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2021.08.003"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfac254"},{"key":"e_1_2_8_7_1","unstructured":"PierreCC GreeneDN MarzinkeM et\u00a0al.Refitting estimated glomerular filtration rate equations to find a fit for all.Association for Diagnostics and Laboratory Medicine 1 July2023.https:\/\/www.myadlm.org\/cln\/articles\/2023\/julaug\/refitting\u2010estimated\u2010glomerular\u2010filtration\u2010rate\u2010equations\u2010to\u2010find\u2010a\u2010fit\u2010for\u2010all(viewed Sept 2023)."},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfac241"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajag.12460"},{"key":"e_1_2_8_10_1","unstructured":"Australia and New Zealand Dialysis and Transplant Registry.Incidence of kidney failure with replacement therapy. 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