Geriatric Kidney Care

Geriatric Kidney Care

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 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.

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.

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).

In the United States, as in many other developed countries, the incidence of treated end stage renal disease (ESRD) increases with advancing age; the highest rates are observed in individuals between the ages of 75 and 79 (Figure 1) (1). There is concern, however, that the functional rehabilitation of elderly dialysis patients is often unsatisfactory and the gain in life expectancy with renal replacement therapy is rather modest.

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.

Figure 1.

Prevalence of CKD in NHANES 1988–-1994 and 1999–2004 by age group (reprinted from JAMA, 2007)

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.

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.