Related Experiment Video
Updated: Aug 13, 2026
08:50
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Therapy insight: how changes in renal function with increasing age affect cardiovascular drug prescribing
Christina M Wyatt1, Michael C Kim, Jonathan A Winston
1Department of Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA. christina.wyatt@mssm.edu
Nature Clinical Practice. Cardiovascular Medicine
|February 1, 2006
Summary
Elderly patients with cardiovascular disease often receive underused therapies due to physician concerns about age-related changes. This review focuses on renal function and medication dosing in older adults with heart conditions.
Area of Science:
- Geriatrics
- Cardiology
- Pharmacology
Background:
- Aging US population increases cardiovascular disease (CVD) burden in older adults.
- Underuse of proven CVD therapies in the elderly stems from physician concerns about frailty and limited understanding of age-related effects.
- Physiologic changes with aging impact medication efficacy, toxicity, and dosing.
Purpose of the Study:
- To review current methods for estimating renal function in elderly patients.
- To discuss unique considerations for prescribing medications to older adults with co-existing renal and cardiovascular disease.
- To highlight the importance of recognizing renal dysfunction for medication safety and dosing in this population.
Main Methods:
- Review of current literature on renal function estimation in the elderly.
- Analysis of age-related physiological changes affecting drug pharmacokinetics and pharmacodynamics.
- Examination of prescribing guidelines and considerations for elderly patients with cardiovascular and renal disease.
Main Results:
- Age-related decreases in lean muscle mass and hepatic function alter drug distribution and metabolism.
- Reduced renal function in the elderly significantly impacts medication safety profiles and necessitates dose adjustments.
- The interplay between renal and cardiovascular disease underscores the critical need for accurate renal function assessment.
Conclusions:
- Accurate estimation of renal function is paramount for safe and effective medication management in elderly patients with cardiovascular disease.
- Understanding age-related physiological changes is crucial for optimizing pharmacotherapy in this demographic.
- Tailored medication strategies considering renal function are essential to improve outcomes for older adults with cardiovascular conditions.
Related Concept Videos
01:18Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion
In geriatric patients, renal physiology undergoes significant changes, including diminished renal blood flow and a lower glomerular filtration rate (GFR), leading to alterations in medication clearance. Drugs such as aminoglycoside antibiotics, lithium, and digoxin, which rely on glomerular filtration for removal from the body, particularly impact pharmacokinetics. These drugs tend to have slower clearance rates in older adults, necessitating careful dosage considerations.Evaluation of renal...
01:15Drug Dosing: Geriatric Patients
Elderly individuals encompass a diverse population with varying degrees of age-related physiological changes. Defining the elderly presents challenges, as the geriatric population is often arbitrarily categorized as individuals older than 65. However, many individuals in this group lead active and healthy lives, with an increasing number surpassing 85 years and falling into the older elderly category. Physiological changes associated with aging impact performance capacity and homeostatic...
01:27Pharmacodynamics in Geriatric Patients: Effects of Age
Age-related pharmacokinetic changes are extensively documented, but understanding age-related pharmacodynamic alterations is relatively limited. This knowledge gap can be partly attributed to the complexity of developing appropriate measures of drug responses compared to bioanalytical methods for determining drug concentrations.Most information regarding age-related differences in human pharmacodynamics originates from cross-sectional studies. However, these studies assume that observed mean...
01:00Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Distribution
Drug distribution in the human body is influenced by several factors, including plasma protein concentration, body composition, blood flow, tissue-protein concentration, and tissue fluid pH. Among these, changes in plasma protein concentration and body composition due to aging significantly affect how drugs are distributed within the body. Specifically, aging is associated with a decrease in albumin levels by about 10% and an increase in α1-acid glycoprotein levels. These alterations are not...
01:18Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Metabolism
Geriatric patients show significant variation in how their bodies process medications, which can change how effective and safe treatments are. The liver is the primary organ where drug metabolism occurs, involving two main types of chemical reactions: phase I and II. Phase I metabolism is driven by the cytochrome P450 enzyme system, which includes key types such as CYP3A, CYP2D6, and CYP2C9. Research indicates that while aging doesn't notably alter the levels or activity of these enzymes, it...
01:22Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Absorption
As individuals age, their body's physiology evolves, affecting drug pharmacokinetics. The most apparent changes occur in the gastrointestinal tract, where an increase in gastric pH, a delay in gastric emptying, and a reduction in gastrointestinal motility are observed. Remarkably, these changes do not substantially modify the absorption of orally administered drugs, particularly those absorbed via passive diffusion.Transdermal drug delivery emerges as a highly viable method for older adults due...