The older adult patient and kidney function

Area of Science:

• Geriatrics
• Nephrology
• Clinical Assessment

Background:

• Older adults frequently experience decreased kidney function.
• Accurate assessment of kidney function is crucial for managing chronic conditions and medication dosing in this population.

Purpose of the Study:

• To review the available methods for assessing kidney function in older adults.
• To inform practitioners about the limitations of current assessment tools and provide guidance on best practices.

Main Methods:

• A comprehensive literature search was conducted using MEDLINE/PubMed and EMBASE databases.
• The search focused on studies published between 1950 and 2010, including English-language human studies of individuals aged 65 and older.
• Included were research articles, reviews, and publications on geriatrics, elderly kidney function assessment, and cystatin C.

Main Results:

• Estimating glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease (MDRD) or Cockcroft-Gault (CG) formulae provides more accurate predictions of kidney function in older adults compared to using creatinine alone or measured creatinine clearance.
• Muscle loss and frailty in older adults complicate the screening and diagnosis of chronic kidney disease, potentially leading to under- or overdiagnosis with current estimation tools.
• Clinicians must exercise caution when interpreting estimated kidney function values in this demographic.

Conclusions:

• No single method for estimating kidney function (eGFR) is definitively validated in older adults.
• Despite limitations, the CG and MDRD equations are commonly used in clinical practice for estimating kidney function in older adults.
• Effective kidney function assessment in the elderly remains a significant clinical challenge, necessitating awareness of the limitations of available methods.