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Chronic kidney disease in the elderly; a silent epidemic
A Martin1, G Mellotte, D O'Neill
1Depts of Medical Gerontology and Nephrology, Trinity Centre for Health Sciences, Adelaide & Meath Hospital, Dublin 24. arhc@amnch.ie
Insights
Chronic kidney disease (CKD) is highly prevalent in elderly patients at geriatric clinics, often undetected by serum creatinine alone. Routine glomerular filtration rate (GFR) calculation is crucial for early intervention and improved prescribing.
Area of Science:
- Nephrology
- Geriatric Medicine
- Internal Medicine
Background:
- Chronic kidney disease (CKD) is linked to increased mortality and morbidity, yet it is underdiagnosed and undertreated in the elderly.
- Early detection and management of CKD are critical for improving patient outcomes.
Purpose of the Study:
- To determine the prevalence of CKD in elderly patients referred to a geriatric medical clinic.
- To identify causative factors and common comorbidities associated with CKD in this population.
Main Methods:
- Glomerular filtration rate (GFR) was calculated using the Cockroft and Gault formula for 101 consecutive patients.
- Data on medications, past medical history, hypertension, and diabetes were collected.
Main Results:
- Mild CKD (GFR <60ml/min) was identified in 80% of patients.
- Serum creatinine alone failed to detect CKD in 90% of cases.
- Hypertension was present in 50%, diabetes in 9%, and nearly one-third received inappropriate drug dosages, commonly NSAIDs.
Conclusions:
- CKD is highly prevalent in older adults attending geriatric clinics and poses significant risks.
- Serum creatinine is an insufficient marker for CKD detection in the elderly.
- Routine GFR calculation is essential for accurate assessment, early intervention, risk factor modification, and optimizing prescribing practices.
Abstract:
Chronic kidney disease has been shown to be associated with significant increases in mortality and morbidity even in early stages. Despite this it is rarely diagnosed, actively investigated or managed in the elderly. We set out to establish the prevalence of CKD and identify causative factors in a consecutive series of referrals to a geriatric medical clinic. We calculated glomerular filtration rates (GFR) for 101 patients attending a geriatric medical clinic using the Cockroft and Gault formula, and collected data on medications and relevant past medical history. Mild CKD (GFR <60ml/min) was present in 80% of the group. Only 10% of these patients had serum creatinine >130(mmol/L. hypertension was present in 50% and only 9% were diabetic. Almost one third were on inappropriate drugs or dosages; most commonly non-steroidal anti-inflammatory drugs (99%). Chronic kidney disease is extremely common in older people attending a geriatric medical clinic and carries significant risks. CKD will not be detected by serum creatinine alone in 90% of cases. Routine calculation of GFR should be used to provide a more accurate measure of renal impairment and allow earlier intervention, risk factor reduction and improve prescribing practices.
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