Related Experiment Video
Updated: Jul 5, 2026
5/6 Nephrectomy Using Sharp Bipolectomy Via Midline Laparotomy in Rats
Published on: April 4, 2025
Recognition and management of chronic kidney disease in an elderly ambulatory population
Michael B Rothberg1, Eileen D Kehoe, Abbie L Courtemanche
1Division of General Medicine and Geriatrics, Baystate Medical Center, Springfield, MA 01199, USA. Michael.Rothberg@bhs.org
Insights
Physicians often miss chronic kidney disease (CKD) in older adults, leading to incorrect medication choices. Improving CKD recognition in the elderly is crucial for safer and more effective patient care.
Area of Science:
- Geriatrics
- Nephrology
- Internal Medicine
Background:
- Chronic kidney disease (CKD) is a significant health concern in the elderly population.
- Early detection of CKD is vital for appropriate management and preventing drug toxicity.
- CKD in the elderly is often undiagnosed due to normal serum creatinine levels, leading to potential treatment errors.
Purpose of the Study:
- To investigate the association between the recognition of CKD in elderly patients and the appropriateness of their medical treatment.
- To assess the impact of diagnosed CKD on prescribing patterns and healthcare utilization.
Main Methods:
- A retrospective chart review was conducted at two academic health centers.
- Included were patients aged 65 years and older with serum creatinine measurements within the last three years.
- Estimated glomerular filtration rate (eGFR) was calculated; for those with eGFR < 60 mL/min, provider documentation, diagnostic tests, referrals, and medication appropriateness were analyzed.
Main Results:
- Out of 814 patients, 33% had moderate (eGFR < 60) and 5% had severe (eGFR < 30) CKD.
- Providers identified only 38% of moderate CKD cases but 87% of severe CKD cases.
- Recognized CKD patients were more likely to receive appropriate medications (ACE/ARB), nephrology referrals, and urine testing, and less likely to receive contraindicated drugs.
Conclusions:
- Physicians frequently fail to diagnose CKD in elderly individuals, resulting in inappropriate treatment.
- Enhanced efforts are needed to improve the identification of elderly patients with reduced glomerular filtration rate (GFR).
- Better CKD diagnosis in older adults can lead to improved treatment outcomes and reduced adverse drug events.
Background:
Chronic kidney disease (CKD) is a growing problem among the elderly. Early detection is considered essential to ensure proper treatment and to avoid drug toxicity, but detection is challenging because elderly patients with CKD often have normal serum creatinine levels. We hypothesized that most cases of CKD in the elderly would go undetected, resulting in inappropriate prescribing.
Objective:
To determine whether recognition of CKD is associated with more appropriate treatment
Design:
Retrospective chart review
Participants:
All patients aged >/=65 years with a measured serum creatinine in the past 3 years at 2 inner city academic health centers.
Measurements:
Estimated glomerular filtration rate (eGFR) calculated using the Modified Diet in Renal Disease equation, and for patients with eGFR < 60, documentation of CKD by the provider, diagnostic testing, nephrology referral and prescription of appropriate or contraindicated medications.
Results:
Of 814 patients with sufficient information to estimate eGFR, 192 (33%) had moderate (eGFR < 60 mL/min) and 5% had severe (eGFR < 30 mL/min) CKD. Providers identified 38% of moderate and 87% of severe CKD. Compared to patients without recognized CKD, recognized patients were more likely to receive an ACE/ARB (80% vs 61%, p = .001), a nephrology referral (58% vs 2%, p < .0001), or urine testing (75% vs 47%, p < .0001), and less likely to receive contraindicated medications (26% vs 40%, p = .013).
Conclusions:
Physicians frequently fail to diagnose CKD in the elderly, leading to inappropriate treatment. Efforts should focus on helping physicians better identify patients with low GFR.
Related Concept Videos
01:28Chronic Kidney Disease III: Interprofessional Care
01:18Chronic Kidney Disease IV: Nursing Management
01:25Chronic Kidney Disease I: Introduction
01:18Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion
01:24Chronic Kidney Disease II: Clinical Manifestations
01:22Acute Kidney Injury VI: Nursing Management