Three years ago, Garet Hil’s daughter’s kidneys failed, and he and his family entered a desperate race to find a living donor for her, including asking 100 family and friends to be tested and entering into every paired organ exchange program that existed in the United States. After several months of angst, they found that Hil’s 23-year-old nephew was a compatible match.
“We dodged the bullet, but it showed me that the United States needs a system to get all incompatible pairs into the database,” to facilitate as many matches between living donors and recipients as possible, Hil said. So
The call had come. A donor was identified for 18-year-old Tim. His path to transplantation was not the smoothest, but in many ways, it was perhaps quite typical. He had received a diagnosis of Alport syndrome at a young age. Throughout his adolescence, his engagement was poor. He had received immunosuppressive therapy for a few years, with fluctuant drug levels. He often sat through appointments without his hearing aids and would provide very little independent information.
When renal replacement therapy loomed near, his mother was intent on a pre-emptive transplant. Immediately, we had concerns about nonadherence and subsequent graft failure.
Speakers at a “Controversies in Organ Transplant Policy” session at Renal Week 2010 described a range of issues affecting both kidney donors and recipients.
Gabriel Danovitch, MD, director of the Kidney Transplant Program at UCLA, described the steps taken this year by the Declaration of Istanbul Custodian Group (DICG) to create a framework of “muscles and tendons” across the “skeleton” of the Declaration. The Declaration of Istanbul was created in 2008 by representatives of scientific and medical bodies from around the world to protect the poor and vulnerable from the negative effects of transplant tourism and organ trafficking.
Elderly persons frequently experience acute kidney injury (AKI). Although studies describing its incidence in this population are difficult to compare because definitions of AKI vary dramatically from study to study, it is clear that the elderly are at the very highest risk for developing the condition. Indeed, Feest and coworkers (1) demonstrated that there is a three- to eightfold progressive, age-dependent increase in the frequency of development of community-acquired AKI in patients over 60.
Over the past 25 years, the mean age of patients with AKI has increased by at least five years and perhaps as much as
Chronic kidney disease (CKD) is likely to be the most common condition managed by practicing nephrologists in elderly patients attending a nephrology clinic. Why? Because the majority of individuals with renal disease are 65 or older (Figure 1) and CKD is the most common renal disease in the older individual.
Prevalence of CKD in NHANES 1988–-1994 and 1999–2004 by age group (reprinted from JAMA, 2007)
Although it is a common condition, and each one of us is clearly able to manage CKD, many would argue that CKD should be considered a different disease for
Chronic kidney disease (CKD) is a relatively common condition in the older American population. An estimated 26 million people in the United States are reported to have CKD. As the population of Americans 65 and older grows, so does the incidence of CKD. Evidence now indicates that kidney disease and aging carry a significant risk for cardiovascular complications and sudden death.
The progressive physiological changes with the aging process are inevitable: Aging-associated changes in carbohydrate metabolism and vascular atherosclerosis markedly increase the risk of developing diabetes and hypertension, and these high incidences of comorbid conditions may also lead to a
Hypertension is common in people 60 and older. With increasing age, it is more likely that someone will experience hypertension and die of coronary heart disease even in the prehypertension range (1, 2) (Figure 1). According to the National Health and Nutrition Examination Survey (NHANES) 1999 to 2006, approximately 67 percent of adults in the United States 60 and older had hypertension, a 10 percent increase from NHANES 1988 to 2004 (3). African Americans and women had a higher prevalence of hypertension than did white individuals, and in those 70 and older
U.S. census data show that the population of individuals over 65 in the United States is growing rapidly and is expected to double over the next 20 years. This means that current fellows can expect to see an increasing number of older patients in professional practice. Average life expectancy is currently around 75.2 years for men and 80.4 years for women, and continues to rise. During the 1990s, the fastest growing population was that of individuals over 85, with 38 percent annual growth, and this group is the largest consumer of health care services.
The end stage renal disease (ESRD) end-of-life coalition was developed by a diverse group of individuals committed to patient-centered end-of-life care for ESRD patients, their families, and their health care providers.
Between March 2000 and October 2001, a Robert Wood Johnson Workgroup focusing on end-of-life issues in the ESRD population addressed quality of life, quality of dying, and educational needs, culminating in a published report (1). The Workgroup developed three primary recommendations: 1) Centers for Medicare & Medicaid Services (CMS) should work with the ESRD Networks to coordinate and link dialysis and hospice care; 2) curricula on end-of-life
In the United States, the number of end stage renal disease (ESRD) patients on maintenance dialysis has increased 20 percent in the last decade to 1700 per million, and 100,000 new cases are added every year. The largest increase in both incident and prevalent cases of ESRD has been in individuals ≥65, with rates three- to fourfold higher compared with younger individuals (Figure 1). Nearly 50 percent of all patients on dialysis are ≥65. This increase in the older patient population is likely due to the increasing prevalence of diabetes and hypertension that has contributed to a rise