Age-dependent changes of the kidneys: pharmacological implications

Area of Science:

• Geriatric Medicine
• Nephrology
• Pharmacology

Background:

• Approximately 40% of drug intoxications occur in the elderly, often due to adverse drug reactions.
• Declining renal function, including reduced renal blood flow and glomerular filtration rate, significantly contributes to drug toxicity in older adults.

Purpose of the Study:

• To review age-dependent changes in kidney function in geriatric patients.
• To examine the consequences of these renal changes for drug therapy and toxicity.

Main Methods:

• Literature review of recent Medline publications.
• Analysis of age-related physiological and functional alterations in the aging kidney.
• Examination of the impact on drug pharmacokinetics and pharmacodynamics.

Main Results:

• Aging kidneys exhibit decreased weight, thickened vasculature, glomerular sclerosis, and stromal fibrosis.
• Altered tubular function affects water, sodium, acid, and glucose handling; endocrine functions are also impaired.
• Reduced urine concentrating ability and sodium conservation increase risks of dehydration and acute renal failure, with drug-induced nephropathy being common.

Conclusions:

• Age-dependent renal functional decline impacts drug pharmacokinetics and pharmacodynamics in the elderly.
• Creatinine clearance is the key indicator for monitoring renal function and guiding drug dosage adjustments.
• The aging kidney is a primary target organ for adverse drug reactions.