{"id":2277,"date":"2022-02-16T14:42:45","date_gmt":"2022-02-16T14:42:45","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/?p=2277"},"modified":"2022-02-24T11:06:06","modified_gmt":"2022-02-24T11:06:06","slug":"age-charts-to-assess-kidney-function","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/2022\/02\/16\/age-charts-to-assess-kidney-function\/","title":{"rendered":"Age Charts to Assess Kidney Function"},"content":{"rendered":"<p><span style=\"font-weight: 400\">Blog entry written on:<\/span> <a href=\"https:\/\/ebm.bmj.com\/content\/early\/2021\/12\/21\/bmjebm-2021-111767\"><em>Kidney trajectory charts to assist general practitioners in the assessment of patients with reduced kidney function: a randomised vignette study<\/em><\/a><span style=\"font-weight: 400\">, <\/span><span style=\"font-weight: 400\">(bmjebm-2021-111767)<\/span><\/p>\n<p><i><span style=\"font-weight: 400\">Authors: <\/span><\/i><i><span style=\"font-weight: 400\">Michelle Guppy, Paul Glasziou, Elaine Beller, Richard Flavel, Jonathan E Shaw, Elizabeth Barr, Jenny Doust.<\/span><\/i><\/p>\n<hr \/>\n<p><span style=\"font-weight: 400\">It\u2019s time to incorporate age into the chronic kidney disease guidelines to better categorise patients\u2019 risk.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Age-related kidney function charts could do just that. To illustrate the folly of ignoring age, consider two patients.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Phyllis is aged 76 and visits her GP for the results of her annual health check.\u00a0 She\u2019s very healthy for her age, and she\u2019s on no medications.\u00a0 The GP checks her kidney function as part of a routine screen and discovers that whilst it is a similar result to 12 months ago, it has now dropped to the range considered \u201cchronic kidney disease\u201d (but is average for her age).\u00a0 The GP considers whether to tell Phyllis she has chronic kidney disease? The GP queries what the average kidney function of a woman Phyllis\u2019 age is, and wonders if there is a tool that could help him determine that.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Brad visits his GP for his annual check-up.\u00a0 Brad is a much younger man, but he recognises the importance of keeping on top of his health because several family members have diabetes and heart disease.\u00a0 Brad gave up smoking 5 years ago and he\u2019s keen to stay healthy.\u00a0 The GP checks Brad\u2019s kidney function and discovers that it is within the \u2018normal\u2019 range, but has dropped a few points in the preceding 12 months.\u00a0 The GP queries what rate of kidney function decline in a younger person should be something to worry about.\u00a0 The GP wonders if there is a tool that could help determine that.<\/span><\/p>\n<p><span style=\"font-weight: 400\">These scenarios are played out in GP consultations on a daily basis.\u00a0 GPs make decisions about their patients\u2019 kidney function and whether it needs to be further investigated, or whether a \u2018watch and wait\u2019 strategy is acceptable. How do GPs make these decisions? Currently guidelines use absolute cut-off values for kidney function, without any reference to a patient\u2019s age.\u00a0 However this can be problematic, with a patient\u2019s kidney function dropping by 50% from its peak before being recognised as abnormal.\u00a0 In a young person, this rapid drop could be cause for concern and further investigation, whereas in an older person, the slow drop may just be a result of age, and as long as the person is careful with what medications they take, may not need any active treatment.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Our paper (Kidney trajectory charts to assist general practitioners in the assessment of patients with reduced kidney function: a randomised vignette study) (bmjebm-2021-111767) presents a \u201ckidney age trajectory chart\u201d as a tool to assist GPs in making decisions about patients\u2019 kidney function, taking age into account in addition to the guidelines. Our chart plots eGFR across the 5th to 95th percentiles and compares this to patient age.\u00a0 We tested this chart on GPs to see how it might change their thinking about a patient\u2019s kidney function. We found that GPs who used the chart were more likely to think an older woman\u2019s kidney function was normal for her age.\u00a0 We also found that GPs who used the chart were more likely to correctly recognise a younger male patient\u2019s kidney function decline as problematic.\u00a0 We think it is time to incorporate patient age into the kidney disease guidelines to assist in making sensible patient-centred decisions.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Example of kidney trajectory charts (Image created by the authors. Used with permission)<\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-2281 size-full\" src=\"https:\/\/blogs.bmj.com\/bmjebmspotlight\/files\/2022\/02\/Picture4.jpg\" alt=\"Image of a chart\" width=\"478\" height=\"660\" srcset=\"https:\/\/blogs.bmj.com\/bmjebmspotlight\/files\/2022\/02\/Picture4.jpg 478w, https:\/\/blogs.bmj.com\/bmjebmspotlight\/files\/2022\/02\/Picture4-217x300.jpg 217w\" sizes=\"auto, (max-width: 478px) 100vw, 478px\" \/><\/p>\n<hr \/>\n<p><strong>Blog Authors<\/strong><\/p>\n<p><strong>Dr Michelle Guppy<\/strong><\/p>\n<p>Institute for Evidence-Based Healthcare, Bond University, Queensland, Australia<br \/>\n<strong>COI:<\/strong> Dr Guppy received a grant from Therapeutic Guidelines Ltd to undertake this research<\/p>\n<p><strong>Dr Paul Glasziou<\/strong><\/p>\n<p>Institute for Evidence-Based Healthcare, Bond University, Queensland, Australia<br \/>\n<strong>COI:<\/strong> reports grants from the Australian National Health and Medical Research Council during the conduct of the study.<\/p>\n<hr \/>\n<p><b>DISCLAIMER<\/b><\/p>\n<p><span style=\"font-weight: 400\">The views and opinions expressed on this site are solely those of the original authors. They do not necessarily represent the views of the BMJ and should not be used to replace medical advice. All information on this blog is for general information, is not peer-reviewed, requires checking with original sources and should not be used to make any decisions about healthcare. No responsibility for its accuracy and correctness is assumed by us, and we disclaim all liability and responsibility arising from any reliance placed on such commentary or content by any user or visitor to the Website, or by anyone who may be informed of any of its content. Any reliance you place on the material posted on this site is therefore strictly at your own risk.<\/span><!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Blog entry written on: Kidney trajectory charts to assist general practitioners in the assessment of patients with reduced kidney function: a randomised vignette study, (bmjebm-2021-111767) Authors: Michelle Guppy, Paul Glasziou, Elaine Beller, Richard Flavel, Jonathan E Shaw, Elizabeth Barr, Jenny Doust. It\u2019s time to incorporate age into the chronic kidney disease guidelines to better categorise [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmjebmspotlight\/2022\/02\/16\/age-charts-to-assess-kidney-function\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":405,"featured_media":2278,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[14375,14351,14437,14436],"tags":[],"class_list":["post-2277","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-bmj-ebm-spotlight","category-ebm","category-kidney-function","category-kidney-trajectory"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Age Charts to Assess Kidney Function - BMJ EBM Spotlight<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmjebmspotlight\/2022\/02\/16\/age-charts-to-assess-kidney-function\/\" \/>\n<meta property=\"og:locale\" content=\"en_GB\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Age Charts to Assess Kidney Function - BMJ EBM Spotlight\" \/>\n<meta property=\"og:description\" content=\"Blog entry written on: Kidney trajectory charts to assist general practitioners in the assessment of patients with reduced kidney function: a randomised vignette study, (bmjebm-2021-111767) Authors: Michelle Guppy, Paul Glasziou, Elaine Beller, Richard Flavel, Jonathan E Shaw, Elizabeth Barr, Jenny Doust. 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