Geriatric Nephrology

Geriatric Nephrology

The United States ESRD population is aging. Patients over the age of 65 have the highest adjusted prevalence of ESRD (Figure 1) (1). As a result of these demographics, nephrology providers are now faced with the task of recognizing and treating not only the burdens of ESRD but also morbidities associated with geriatric syndromes (Table 1). Prognosis for the elderly encompasses survival as well as effects on quality of life (QOL), cognition, functional status, and time lost from being with family.

“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

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 (1). CKD stages 1 and 2 are characterized by a GFR >60 mL/min/1.73 m2, and dose adjustments are usually indicated only for drugs that have a narrow therapeutic index, such as aminoglycosides and vancomycin.

Diabetes mellitus is the most common cause of chronic kidney disease (CKD) and kidney failure (1). More than one quarter of the United States population over age 65 has diabetes (2), and 37 percent of them have an eGFR <60 mL/min/1.73 m2 (3).

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 (1).

We are aging and living longer. This fact could be attributed to improved technology, medical advances, and the increased number and aging of the baby boomers. It is estimated that the number of elderly will be up to 2 billion by the year 2050 (1). This increase in the number of elderly is mirrored by an increase in medical problems such as acute and chronic kidney disease. This requires coordinated care by multiple specialties, with geriatricians and nephrologists playing a key role in the treatment of these patients.

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 (1). However, the significance of reduced GFR in the elderly has been debated, and some suggest that reduced GFR is secondary to (expected) age-related changes in kidney function and is not evidence of true kidney disease.

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 (1). Furthermore, the prevalence increases with age; 65 percent of individuals over the age of 60 are hypertensive. Approximately three-quarters of the population with diagnoses of hypertension require some form of pharmacologic therapy, and the percentage is as high as 82 percent among individuals over the age of 60.