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Comprehensive management of chronic kidney disease in the old population
Ma Eugenia Portilla Franco1, Adriana Puente-García2, Luis M Pérez-Belmonte3,4
1Geriatrics Service, Hospital Clínico San Carlos, Madrid, Spain.
Insights
Chronic kidney disease (CKD) is common in older adults but often underdiagnosed. Comprehensive management, including lifestyle changes and risk factor control, improves outcomes for elderly patients with CKD.
Area of Science:
- Nephrology
- Geriatrics
- Public Health
Background:
- Chronic kidney disease (CKD) is a global health concern, increasing inflammation and risk of advanced disease, renal replacement therapy, and cardiovascular issues.
- CKD prevalence escalates with age, impacting 25-30% of older adults, yet it remains significantly underdiagnosed in this demographic.
- Diagnosis in older adults is challenging due to limited accurate tests, reliance on creatinine-based formulas affected by low muscle mass, and age-related decline in renal function.
Purpose of the Study:
- To provide an updated narrative review on the epidemiology, clinical profile, and management of CKD specifically in the elderly population.
- To highlight the diagnostic challenges and emphasize the need for comprehensive management strategies tailored to older adults with CKD.
Main Methods:
- This study is a narrative review, synthesizing current literature on CKD in older adults.
- The review covers epidemiology, clinical characteristics, diagnostic difficulties, and management approaches.
Main Results:
- CKD significantly increases morbidity and mortality in older adults, including cardiovascular disease, hospitalizations, and reduced quality of life.
- Underdiagnosis is prevalent due to complex diagnostic factors in the elderly.
- Comprehensive management, integrating lifestyle, risk factor control, and tailored medical therapies, is crucial.
Conclusions:
- Effective management of CKD in older adults requires a holistic approach, addressing comorbidities and geriatric syndromes.
- Patient involvement in care decisions is essential for successful management and improved outcomes.
- Updated knowledge on CKD epidemiology and management in the elderly is vital for clinical practice.
Abstract:
Chronic kidney disease (CKD) is a global issue that raises inflammation and heightens the risk of progressing to advanced CKD, requiring renal replacement therapy. It also significantly increases the likelihood of cardiovascular and vascular diseases, hospitalizations, functional decline, and reduced quality of life, particularly in older adults. CKD prevalence rises with age, affecting 25-30% of older adults. Despite that, the fact is that CKD is underdiagnosed in this population. Diagnosing CKD in older patients is difficult because accurate tests are limited, common serum creatinine-based formulas depend on muscle mass (often low in this group), and age-related renal function decline further complicates assessment. Comprehensive management can help achieve therapeutic goals in the old population with CKD through assessments and care plans. This care includes a combination of lifestyle changes, cardiovascular risk factors control, the use of drugs with proven renal and cardiovascular benefits, as well as the adequate management of specific clinical conditions, including the general clinical comorbidities, renal-related conditions and recognition of geriatric syndromes, helping patients manage their condition and involving them in decisions about their care. In this narrative review, the epidemiology, clinical profile and management of CKD in the old population are updated.
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