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Outcomes in CKD: what we know and what we need to know

Laura E Clark1, Izhar Khan

  • 1Department of Renal Medicine, Royal Infirmary Edinburgh, Edinburgh, UK. lauraclark77 @ hotmail.com

Nephron. Clinical Practice
|November 6, 2009
PubMed

Insights

Chronic kidney disease (CKD) in the elderly may not always warrant a disease label, as cardiovascular death is more common than kidney failure. Focus specialist care on high-risk CKD patients, while most elderly individuals can be managed in primary care.

Area of Science:

  • Nephrology
  • Geriatrics
  • Public Health

Background:

  • Chronic kidney disease (CKD) is a significant public health issue, particularly concerning reduced estimated glomerular filtration (eGFR) in the elderly.
  • The clinical significance of CKD definitions, especially in older populations, remains uncertain regarding morbidity, mortality, and progression to end-stage renal disease (ESRD).
  • Cardiovascular disease (CVD) is a leading cause of death in CKD patients, often surpassing progression to renal replacement therapy.

Purpose of the Study:

  • To evaluate the clinical significance of CKD definitions in the elderly.
  • To identify risk factors for progression to ESRD.
  • To determine appropriate management strategies for elderly CKD patients.

Main Methods:

  • Review of existing data on the natural history of CKD in the elderly.
  • Analysis of factors influencing progression to ESRD.
  • Comparison of mortality rates from CVD versus ESRD in elderly CKD patients.

Main Results:

  • Cardiovascular disease mortality is significantly more common than progression to ESRD in the elderly CKD population.
  • Factors such as younger age, proteinuria, and diabetes are associated with an increased risk of progression to ESRD.
  • Younger CKD patients face substantially increased relative risks of death compared to the elderly.

Conclusions:

  • Specialist renal review should be prioritized for high-risk CKD patients (younger age, proteinuria, diabetes).
  • The majority of elderly CKD patients can be safely monitored in primary care settings.
  • Labeling all elderly CKD patients with a 'disease' may not confer additional benefits and warrants further consideration.

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