Gembillo G, Soraci L, Santoro D. Chronic kidney disease in geriatric patients: Estimating glomerular filtration rate in older patients with comorbidities. World J Nephrol 2025; 14(2): 105803 [DOI: 10.5527/wjn.v14.i2.105803]
Corresponding Author of This Article
Guido Gembillo, MD, PhD, Assistant Professor, Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria, 1, Messina 98125, Sicilia, Italy. guidogembillo@live.it
Research Domain of This Article
Urology & Nephrology
Article-Type of This Article
Letter to the Editor
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Nephrol. Jun 25, 2025; 14(2): 105803 Published online Jun 25, 2025. doi: 10.5527/wjn.v14.i2.105803
Chronic kidney disease in geriatric patients: Estimating glomerular filtration rate in older patients with comorbidities
Guido Gembillo, Luca Soraci, Domenico Santoro
Guido Gembillo, Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, Messina 98125, Sicilia, Italy
Luca Soraci, Unit of Geriatric Medicine, Italian National Research Center on Aging (IRCCS INRCA), Cosenza 87100, Calabria, Italy
Domenico Santoro, Unit of Nephrology and Dialysis, AOU "G. Martino", University of Messina, Messina 98125, Sicilia, Italy
Co-first authors: Guido Gembillo and Luca Soraci.
Author contributions: Gembillo G and Soraci L contribute equally to this study as co-first authors; Gembillo G, Soraci L and Santoro D collaborated on this manuscript.
Conflict-of-interest statement: We declare no conflict of interest.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Guido Gembillo, MD, PhD, Assistant Professor, Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria, 1, Messina 98125, Sicilia, Italy. guidogembillo@live.it
Received: February 7, 2025 Revised: March 7, 2025 Accepted: March 21, 2025 Published online: June 25, 2025 Processing time: 61 Days and 16.4 Hours
Abstract
Aging is an inevitable process that is usually measured by chronological age, with people aged 65 and over being defined as "older individuals". There is disagreement in the current scientific literature regarding the best methods to estimate glomerular filtration rate (eGFR) in older adults. Several studies suggest the use of an age-adjusted definition to improve accuracy and avoid overdiagnosis. In contrast, some researchers argue that such changes could complicate the classification of chronic kidney disease (CKD). Several formulas, including the Modification of Diet in Renal Disease, CKD-Epidemiology Collaboration, and Cockcroft-Gault equations, are used to estimate eGFR. However, each of these formulas has significant limitations when applied to older adults, primarily due to sarcopenia and malnutrition, which greatly affect both muscle mass and creatinine levels. Alternative formulas, such as the Berlin Initiative Study and the Full Age Spectrum equations, provide more accurate estimates of values for older adults by accounting for age-related physiological changes. In frail older adults, the use of cystatin C leads to better eGFR calculations to assess renal function. Accurate eGFR measurements improve the health of older patients by enabling better medication dosing. A thorough approach that includes multiple calibrated diagnostic methods and a detailed geriatric assessment is necessary for the effective management of kidney disease and other age-related conditions in older adults.
Core Tip: Older people often battle with multiple health issues, such as diabetes, high blood pressure and heart disease, making treatment considerably more challenging, particularly if they have kidney problems. This specific cohort presents a meaningful diagnostic challenge in identifying kidney problems because of the large difficulty in differentiating normal aging from early chronic kidney disease. Accurate glomerular filtration rate estimation is important to prevent misdiagnosis, improper treatment and medication errors resulting from inaccurate calculations.
