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This chapter addresses the following Geriatric Fellowship Curriculum Milestones: #9, #18

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LEARNING OBJECTIVES

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Learning Objectives

  • Understand normal kidney aging.

  • Classify kidney disease using the estimated glomerular filtration rate (eGFR).

  • Recognize environmental factors impact the rate of decline in kidney function.

  • Recognize that genetic factors play a role in the age-related decline of kidney function.

  • Understand the general guidelines for managing patients with CKD.

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Key Clinical Points

  1. All older adults have some decline in renal function.

  2. Older patients can typically maintain normal physiologic homeostasis, but are compromised in their ability respond to challenge.

  3. Kidneys become more susceptible to injury with advancing age.

  4. Rates of decline in renal function in aging are quite variable and impacted by both genetic and environmental factors.

  5. Preventing people from reaching end-stage renal disease reduces cost of care and greatly improves quality of life.

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CLINICAL RELEVANCE

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Kidney failure is a growing problem in the older population. Data on people reaching end-stage kidney disease (ESKD) is collected by the US Renal Data System (USRDS). All dialysis units that receive funding from Medicare are required to file data with the USRDS, so that national data are available on over 95% of people receiving renal replacement therapy. Information published in the 2014 USRDS annual data report shows that approximately 1.3 in 1000 persons aged 65 to 69 years are initiating treatment for ESKD each year. For the 70- to 75-year-old age group the incidence rate is 1.68 per 1000 persons, a growth rate of 7.1% per year. The peak incidence occurs in the 80 to 84 age group at 1.8 per 1000 population. Incidence rates over age 85 then fall to 1.36 per million population. Over the last 10 years, the number of older people enrolling for treatment has increased by 41% in the group of people aged 75 years or older and by 48% in the plus 80-year-old age group. Over 6 persons in 1000 are currently maintained on renal replacement therapy, with the plus 75-year-old age group growing at 10% per year. The peak incidence for ESKD is the 80- to 84-year-old age group. In contrast, the incidence of ESKD in the 20- to 44-year-old age group has remained flat over the last 10 years, with only modest growth in the 45- to 64-year-old group. Although some of the increase in renal replacement therapy for the older population indicates a greater willingness to offer treatment to older individuals, much of the increase is owing to people surviving to experience the chronic changes that occur with aging. The kidney undergoes significant age-related change. Other common diseases such as hypertension and diabetes accelerate these changes.

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THE AGING PROCESS

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Aging in the kidney is characterized by changes of both structure and function. It must be emphasized that many of the aging studies have been performed on laboratory animals, particularly rodents, that demonstrate quite ...

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