Renal vascular disease in the elderly

Area of Science:

• Nephrology
• Geriatrics
• Vascular Medicine

Background:

• Western societies face an increasing number of elderly patients over 65 requiring dialysis.
• Diabetic nephropathy and renal vascular disease (RVD) are the leading causes of end-stage renal disease (ESRD), accounting for over 50% of cases.
• RVD is now the primary cause of ESRD in the elderly, representing 38% of cases in this demographic.

Purpose of the Study:

• To analyze the changing landscape of end-stage renal disease (ESRD) causes in aging populations.
• To investigate the prevalence, natural history, diagnosis, and prognosis of renal vascular diseases (RVD) leading to ESRD in the elderly.
• To highlight the underdiagnosis of atheromatous RVD and potential overestimation of nephrosclerosis.

Main Methods:

• Analysis of registry data (EDTA, USRDS) on dialysis patient demographics and causes of ESRD.
• Review of literature concerning hypertensive RVD (nephrosclerosis), atheromatous RVD, and acute renal artery occlusion.
• Discussion of diagnostic challenges, including the presumed diagnosis of nephrosclerosis and underdiagnosis of atheromatous RVD.

Main Results:

• Renal vascular disease (RVD) is the leading cause of end-stage renal disease (ESRD) in elderly patients (38%).
• Hypertensive RVD, atheromatous RVD, and acute renal artery occlusion are the main RVDs causing ESRD in the elderly.
• Nephrosclerosis diagnosis is often presumed and overestimated, while atheromatous RVD is frequently underdiagnosed.

Conclusions:

• Aging populations are shifting the etiology of end-stage renal disease (ESRD) towards vascular causes.
• Accurate diagnosis of atheromatous RVD is crucial for understanding its true prevalence and impact on prognosis.
• Further research and improved diagnostic strategies are needed for renal vascular diseases (RVD) in the elderly.