Does the diagnosis and classification of CKD need to change based on age? CKD is a global health problem, and more than half of all people over the age of 70 have CKD. like hypertension, diabetes, and hyperlipidemia, all increase the risk of cardiovascular disease. And none of these diseases have been redefined and graded according to age. CKD should not be defined in a rigid way, and our ultimate goal is prevention and treatment. It is not necessary to define CKD by different ages Defining CKD according to age is too complicated and requires a combination of age, GFR, and proteinuria, which can create problems such as patients just getting older without a change in physical status, while the diagnosis changes. Dividing by age is not going to affect the treatment plan because the patient’s treatment is based on GFR and proteinuria, not the diagnosis. This makes the classification by age meaningless. The current CKD classification criteria are universally accepted and do not change with age The 2012 KDIGO (Kidney Disease Improvement Global Prognosis Organization) still follows the definition proposed in 2002, which is based on clinical, scientific and public health. The classification is still based on glomerular filtration rate (GFR), but with the addition of albumin and etiology classification (CGA staging). A new method was added to assess CKD prognosis using risk prediction. Early stages of CKD are often asymptomatic, so KDIGO recommends the use of laboratory tests to monitor people at risk. The CKD-EPI (Chronic Kidney Disease Epidemiology Collaborative Group) formula, which estimates GFR based on blood creatinine, cystatin C. The protein creatinine ratio of random urine is used to assess proteinuria. The accuracy of this method does not change with age. CKD in the elderly cannot be explained by age alone There are many studies showing lower GFR and higher urinary protein in the elderly. So it is assumed that these are natural changes that should occur with age. However, there is evidence that these are not age-related. 1, GFR and urine protein vary greatly between older adults. 2, Low GFR and high urine protein are associated with other abnormalities in kidney function and structure, such as decreased renal blood flow, decreased renal concentration and acidification, glomerular and arteriosclerosis, and tubular atrophy, all of which are pathological. 3. Because GFR and urinary protein are correlated with the severity of vascular lesions, these abnormalities may be caused by renal vascular lesions. Therefore, efforts to find the causes affecting GFR and proteinuria are the most important, rather than just explaining them by age. Is reduced GFR in elderly patients pathologic CKD or physiologic decline in renal function? Elderly patients are concerned about whether the current decrease in GFR is pathological CKD or physiological decline in renal function, and doctors should be patient in explaining this. There are many examples of benefits that can be derived from treating problems that are recognized to occur in old age (e.g., hypertension, hyperlipidemia, hyperuricemia, etc.). The few treatment options currently established and the lack of proper analysis of the results of previous trials are calls for physicians to actively change the status quo of inaction. CKD increases risk in older adults Low GFR and high proteinuria increase risk in all populations, but there are differences between older and younger adults. Studies have shown that older adults with low GFR and high proteinuria have a low relative risk of mortality but a high excess risk. The relationship between renal failure and mortality is similar. This may be due to the diversity of cardiovascular risk factors in the elderly. The prediction is that these abnormalities are not produced by older age. Call for what everyone should do The definition of CKD and CGA staging developed by the 2012 KDIGO guidelines should be promoted. Detection, assessment and treatment should be individualized, and screening is needed in all high-risk groups, including creatinine-based GFR and urinalysis. The etiology and the presence of complications should be analyzed to predict the survival of patients. What doctors need to do now is to seek the reasons why CKD is so prevalent, find effective ways to prevent and treat it, and pay attention to what matters to patients.