Faculty Articles


Evaluation and Management of the Older Adult with Chronic Kidney Disease



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Nephrology, Primary Care: Clinics in Office Practice Nephrology





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Chronic kidney disease (CKD) has a high prevalence in the elderly population. Almost half of the population reaches moderate impairment (CKD 3) by the age of 65.¹ We describe the complexities of CKD staging in the geriatric population and several of the common clinical presentations of renal disease. Management of bone disease in geriatric patients with CKD may require a different approach. ² Diagnosis and treatment regimens of chronic renal disease are discussed. Geriatric patients are at increased risk for renal dysfunction due to many etiologies. Some causes are inherent with aging, such as gross structural and cellular changes, decrease in physiologic function, and a lowered vascular compensatory reserve.³ The decision to pursue renal biopsy in diagnosis of the elderly patient will be explored. Exposures, including medications and diagnostic testing, can contribute to acute-on chronic kidney disease. Insults to renal function are also the result of co-morbid diseases. Diabetic kidney disease (DKD) is the most common cause of CKD. 4 In the elderly diabetic patient, the risk of mortality is higher than that of progression to end stage renal disease (ESRD).4 Adequate glucose and blood pressure control are encouraged in the geriatric patient with CKD, however, within the current framework of guidelines to avoid adverse effects, particularly in frail patients with limited life expectancy. Early control of microalbuminuria and timely referral to a nephrologist are crucial to delaying ESRD, aiding decision-making regarding renal replacement therapy, and decreasing mortality secondary to cardiovascular events in the setting of DKD. 4 The progression of CKD can have a significant effect on the overall prognosis of a geriatric patient. The Multidimensional Prognostic Index (MPI), based on comprehensive geriatric assessment data such as medical co-morbidities, cognition, and overall functional status, has been shown to be a more powerful prognostic tool for determining 1-year mortality of CKD patients in the acute care setting.5 Hospice inclusion criteria for ESRD and CKD, and palliative decision-making tools, such as the Charlson Comorbidity Index, will be covered. The geriatric patient with CKD needs to be assessed in a comprehensive manner in order to form an individualized, appropriate, and patient-centered care plan. CKD management is addressed in the complex setting of increasing longevity, multiple disciplinary guidelines, and comprehensive assessment.


Medical Specialties | Medicine and Health Sciences | Osteopathic Medicine and Osteopathy


acute kidney injury (AKI), chronic kidney disease (CKD), kidney failure, older adult, renal replacement therapy (RRT)

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