Chronic kidney disease in older people - diagnosis, aetiology and consequences

The prevalence of chronic kidney disease (CKD) steeply rises with age but there is controversy regarding the diagnosis and clinical significance of CKD in older people. This article reviews recent advances in our understanding with respect to the diagnosis, aetiology and adverse outcomes associated with CKD in older people.

Comparisons with measured glomerular filtration rate in a cohort of older people found that the Chronic Kidney Disease Epidemiology Collaboration equation using creatinine and cystatin C performs at least as well as other equations developed to estimate glomerular filtration rate in older populations. Several studies have identified modifiable risk factors in earlier life that are associated with increased risk of developing CKD in later life, including blood pressure, biomarkers of cardiovascular disease and lower serum bicarbonate. Numerous studies have confirmed that CKD in older people is associated with an increased risk of multiple adverse outcomes including death, end-stage kidney disease, cardiovascular events, acute kidney injury, severe infections and cognitive decline.

CKD is associated with the same adverse outcomes in older people as younger people. Further studies are required to develop interventions to reduce the incidence of CKD in older people and improve the associated adverse outcomes.