Analysis Too Much Medicine

Chronic kidney disease controversy: how expanding definitions are unnecessarily labelling many people as diseased

BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f4298 (Published 30 July 2013) Cite this as: BMJ 2013;347:f4298

Re: Chronic kidney disease controversy: how expanding definitions are unnecessarily labelling many people as diseased

Within their detailed and helpful response to Moynihan et al, Coresh et al write: “we find the attitude that disease in older people should be ignored and untreated to be disturbing.” Quite apart from the fact that I can detect no such attitude in the Moynihan article, this seems worrying for two main reasons.

Firstly, the authors persist in confusing risk with disease. As Jones points out in his response, a low estimated GFR and albuminuria are not diseases in themselves but risk factors for future problems. Describing people with risk factors as diseased is both unhelpful and demoralising to those patients so described.

Secondly, it is well time that we paid more attention to the realities of normal physiological ageing and stopped trying to correct every biometric parameter to the norms of younger adults. This process, which is becoming more and more pervasive, is resulting in the overmedicating of a whole generation of older people with all the adverse effects that polypharmacy creates.

Competing interests: I am a a member of the scientific committee organising the Preventing Overdiagnosis conference in Dartmouth, US, in September.

16 August 2013
Iona Heath
retired GP
none
Islington, London
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