ReviewInternational urology and nephrology2026
Keller/eGFR ratio as a simple and useful tool to make a first differentiation between renal aging and chronic nephropathy in large populations.
Review in International urology and nephrology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed.
- "One Size Does Not Fit All" is only the beginning: the need for proportional, patient-level decisions in elderly CKD.International urology and nephrology · 2026Article
- Kidney function in older adults: from eGFR to a phenotype- and frailty-informed approach.International urology and nephrology · 2026Article
- The Keller/eGFR ratio, frailty, and measured GFR: towards a new diagnostic framework for CKD in the elderly.International urology and nephrology · 2026Article
- Frailty and chronic kidney disease: beyond risk prediction toward frailty-informed CKD classification.International urology and nephrology · 2026Article
- Renal Dose Adjustment in European Primary Care: Clinical Nuances and Practical Challenges.Journal of clinical medicine · 2026Article
- Prediction is not decision: why frailty must guide clinical choices in hemodialysis.International urology and nephrology · 2026Article
- Response to letter to Editor: "Unaddressed limitations in the reclassification of CKD in the elderly: a brief critique" by Hassan MB, Raza R, Rani E, Saleem MH, Dar BA, Karim A.International urology and nephrology · 2026Article
- Diabetes Duration Is Associated with Declining Kidney Function: eGFR and CKD Burden Across Duration.Journal of clinical medicine · 2026Article
- Unaddressed limitations in the reclassification of CKD in the elderly: a brief critique.International urology and nephrology · 2026Article
- Reassessing CKD staging in the elderly: methodological and clinical concerns.International urology and nephrology · 2026Article
- Reclassification of chronic kidney disease in the elderly: emphasizing the need for longitudinal outcome validation.International urology and nephrology · 2026Article
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Authors and funding
3 authors.
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Abstract
backgroundChronic kidney disease (CKD) prevalence increases with age, but distinguishing physiological renal ageing from pathological CKD remains a major diagnostic challenge. Current CKD definitions based solely on estimated glomerular filtration rate (eGFR) often lead to overdiagnosis in elderly individuals with normal age-related decline. This study explores the use of the Keller/eGFR ratio as a simple and useful tool to differentiate normal renal ageing from true nephropathy in large populations.
methodsKeller formula (GFR = 130-age) was applied to model the expected physiological GFR decline across the lifespan. The ratio between Keller-derived GFR and measured eGFR (CKD-EPI) was analyzed to distinguish physiological ageing (Keller/eGFR ≤ 1) from pathological decline (Keller/eGFR > 1). The approach was compared with classical biochemical, urinary, and imaging markers and validated using data from the Abruzzo cohort of older adults.
resultsKeller/eGFR ratio provided a clear separation between individuals with expected age-related GFR reduction and those with evidence of underlying CKD. In patients with Keller/eGFR ≤ 1, biochemical parameters (creatinine, urea, hemoglobin, calcium-phosphorus metabolism) and urinalysis remained within normal limits, and imaging findings were unremarkable. Conversely, Keller/eGFR > 1 was associated with typical CKD features, including anemia, mineral abnormalities, and structural renal alterations. Integrating this ratio with clinical and laboratory data significantly reduced CKD overdiagnosis in elderly subjects.
conclusionsThe Keller/eGFR ratio represents a practical, low-cost, and easily applicable index for the first-line screening of kidney function in older adults. When combined with biochemical and imaging markers, it enhances diagnostic accuracy and helps avoid excessive medicalization related to CKD misclassification. Wider implementation in population studies could improve epidemiological stratification and resource allocation in nephrology care.
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