Intended for healthcare professionals

Letters Chronic kidney disease definition

Whatever happened to normal ageing?

BMJ 2013; 347 doi: (Published 18 September 2013) Cite this as: BMJ 2013;347:f5572
  1. Iona Heath, retired GP1
  1. 1London, UK
  1. iona.heath22{at}

Within their detailed and helpful response to Moynihan and colleagues’ article,1 Coresh and colleagues write that “the attitude that disease in older people should be ignored and untreated is disturbing.”2 Apart from the fact that I detected no such attitude in the Moynihan article, this is worrying for two main reasons.

Firstly, the authors persist in confusing risk with disease. As Jones points out in his response,3 a low estimated glomerular filtration rate and albuminuria are not diseases in themselves but risk factors for future problems. Describing people with risk factors as having a disease is unhelpful and demoralising to these people.

Secondly, it is 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.


Cite this as: BMJ 2013;347:f5572


  • Competing interests: IH is a member of the scientific committee organising the Preventing Overdiagnosis conference in Dartmouth, US, in September.


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