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In the United States we are currently experiencing the phenomenon of the “graying of America,” whereby the population is growing older and the proportion of those 65 years and older is rapidly increasing. Data from the U.S. Census Bureau predict that the number of individuals 65 years and older will double in the next 20 years. Most of this growth is happening in the “oldest old”—that is, 85 years and older. Among other challenges, the aging of the population brings the increasing burden of chronic disease conditions such as diabetes, hypertension, and heart disease (
Diabetes mellitus is the most common cause of chronic kidney disease (CKD) and kidney failure (
Whether the decreased GFR is due to age-related decline or to diabetic kidney disease (see other articles in this issue), it affects the clearance of insulin and many diabetes medications and raises the risk of hypoglycemia (
Chronic kidney disease (CKD) is a prevalent disease in the United States that disproportionately affects the elderly. The national prevalence is approximately 15 percent and reaches nearly 50 percent in adults aged 70 years and older (
“If you really want to do something, you’ll find a way. If you don’t, you’ll find an excuse.” —Jim Rohn, American entrepreneur, author, and motivational speaker
Arguably, the biggest problem facing end-of-life decision making in elderly patients with advanced and end stage renal disease is that conversations about the end of life simply don’t happen often enough. In one survey of dialysis patients, fewer than 10 percent reported having a conversation about end-of-life issues with their nephrologist in the past year. Moreover, fewer than 10 percent reported that any physician had ever discussed prognosis with them (
In the United States, chronic kidney disease (CKD)—defined by reduced GFR <60 mL/min per 1.73 m2, or presence of kidney damage—is very common in the elderly population. The prevalence of CKD is estimated to be 46.8 percent in those older than 70 years (
The United States ESRD population is aging. Patients over the age of 65 have the highest adjusted prevalence of ESRD (
Hypertension remains a growing problem in our aging population. Recent data from the National Health and Nutrition Examination Survey (NHANES) estimate that almost one-third of the adult population meets the criteria for hypertension (
The Framingham Heart Study helped to elucidate the expected trajectory of blood pressure in normotensive and
Although there has been an overall slowing of incident cases of ESRD in the United States during the past several years, the elderly population continues to have the highest incident rates of ESRD (
One of the major challenges for today’s society is the growth of the elderly population. By 2030, the age segment over 65 years will have nearly doubled, and the incidence of multiple age-associated disorders is predicted to increase in parallel. Age-associated changes of the kidney are important not only because normal aging alters renal function, but also because of the high frequency of ESRD in the elderly population (
Patients’ access to specialized care before kidney failure develops varies significantly across the United States and among different racial groups. And perceived racial discrimination may have negative effects on kidney function.
Pre-ESRD nephrology care is crucial for optimizing the health of patients with this condition. How the United States and global kidney community ensure such care for the millions of people with kidney disease is crucial to stemming the disease’s growing prevalence.
One approach is to look at the adequacy of care patients receive in different parts of the country and then examine the reasons for discrepancies in care.
Brendan
