Is Chronic Kidney Disease in Older People a New Geriatric Giant?

Ahmed H Abdelhafiz; Shameela Ahmed; Katie Flint; Meguid El Nahas

Disclosures

Aging Health. 2011;7(5):749-762. 

In This Article

Abstract and Introduction

Abstract

The global population is aging, and the number of people above the age of 85 years is growing faster than any other age group. There is an age-related decline in kidney function; however, not all individuals will develop chronic kidney disease (CKD) with advancing age. Those who are genetically predisposed and exposed to lifetime cardiovascular risk factors are likely to develop systemic atherosclerosis and CKD as a part of its manifestation. CKD promotes poor health through its association with inflammation and oxidative stress. Malnutrition, weight loss and sarcopenia are common in CKD patients, leading to poor outcomes, such as physical and cognitive dysfunction, manifesting as major geriatric syndromes. Frailty is likely to be one of the underlying processes that leads to the clinical manifestations of geriatric syndromes in patients with CKD. Therefore, functional outcomes, such as cognition and physical functioning, might be more relevant outcomes to older patients with CKD. Interventions should be developed and assessed in terms of maintaining quality rather than quantity of life before disability develops.

Introduction

The elderly population is growing. In 2003, people aged over 65 years comprised 12% of the total population of the USA. This number is projected to increase to 20% in 2030. In addition, patients aged over 85 years represented 1.6% of the total population of the USA in 2003, but they are projected to double by 2030 and to double again by 2050.[1] As life expectancy increases, more elderly patients are surviving longer with chronic conditions in particular cardiovascular disease and chronic kidney disease (CKD). Age may be interpreted as an increased risk of exposure time to traditional cardiovascular risk factors, such as smoking, diabetes, dyslipidaemia and a sedentary lifestyle. Thus, the increase in cardiovascular disease in older people can be viewed as an interaction between age (exposure time), cardiovascular risk factors and genetic factors.[2] Individuals with both genetic and environmental risk factors for cardiovascular disease develop age-related vascular pathology with diffuse atherosclerosis (unsuccessful aging). On the other hand, successful aging could be defined as aging with lesser dysfunction and without the development of major chronic diseases.[3] This implies that glomerular filtration rate (GFR) may decline physiologically with age without evidence of renal dysfunction, while CKD with evidence of renal damage, such as albuminuria, is likely to be a manifestation of broader age-related diffuse vascular damage, affecting a number of end organs, including the heart, kidneys, brain and eyes.[4] Therefore, advanced age alone is not responsible for kidney damage or a primary renal disease but its coexistence with other comorbid conditions, such as hypertension, diabetes and atherosclerosis, may accentuate such damage.[5] The pathophysiologic mechanisms underlying age-related decline in kidney function, the interactions between age and other risk factors in renal function progression, and the associations of CKD with other comorbidities common in old age are less clear. This article summarizes age-related renal and vascular changes and renal function assessment, and explores the systemic nature of CKD and its association with geriatric syndromess mainly physical and cognitive dysfunction in older people.

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