Abstract
Chronic kidney disease (CKD) is prevalent in 13% of US community-dwelling adults and over 46% of those >70 years of age. Improved recognition of this wide prevalence in the past 10–15 years has produced standardized staging of CKD, a platform for public health education and surveillance, ongoing research, and guidelines for secondary and tertiary prevention. Such measures are necessary in confronting an often subclinical disease that has massive public health consequences. The vast majority of CKD patients are older adults, due in most cases to decades of hypertension, diabetes and obesity. Many challenges remain in confronting the epidemic of CKD in older adults. Certain structural and functional reductions in the kidney are part of normal aging but mimic CKD, making distinction between routine renal senescence and renal pathology difficult. The most common serum markers and medical formulae for assessing renal function are at times inaccurate in older adults. Improved markers and equations are emerging, but are not yet widely available or perfected. The course of CKD, its risk factors and its associated morbidity and mortality risks are also increasingly recognized to diverge in older compared to younger CKD patients. More research and guidelines are needed to improve risk assessment and diagnosis, and to tailor the care of this largest CKD subpopulation.
Keywords
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Abbreviations
- AASK:
-
African American Study of Kidney Disease
- ACCORD:
-
Action to Control Cardiovascular Risk in Diabetes
- ACEI:
-
Angiotensin-Converting Enzyme Inhibitor
- ADVANCE:
-
The Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation
- AKI:
-
Acute Kidney Injury
- ALLHAT:
-
Antihypertesive and Lipid-Lowering Treatment to Prevent Heart Attack Trial
- ARBs:
-
Angiotensin Receptor Blockers
- BLSA:
-
Baltimore Longitudinal Study of Aging
- CKD:
-
Chronic Kidney Disease
- eGFR:
-
Epidermal Growth Factor Receptor
- ESRD:
-
End Stage Renal Disease
- GFR:
-
Glomerular Filtration Rate
- ICD-9:
-
International Statistical Classification of Diseases and Related Health Problems, Ninth Edition
- MDRD:
-
Modification of Diet in Renal Disease
- NHANES:
-
National Health and Nutrition Examination Survey
- NKF-KDOQI:
-
National Kidney Foundation Kidney Disease Outcomes Quality Initiative
- SHARP:
-
Study of Heart and Renal Protection
- SPRINT:
-
Systolic Blood Pressure Intervention Trial
- UKPDS:
-
UK Prospective Diabetes Study
References
US Renal Data System (2010) USRDS annual data report: atlas of chronic kidney disease and end-stage renal disease in the United States. Accessed 31 Oct 2010
Mc Greevy C, Horan J, Jones D et al (2008) A study of tubular potassium secretory capacity in older patients with hyperkalaemia. J Nutr Health Aging 12:152–155
Weinstein JR, Anderson S (2010) The aging kidney: physiological changes. Adv Chronic Kidney Dis 17:302–307
Lindeman RD, Tobin J, Shock NW (1985) Longitudinal studies on the rate of decline in renal function with age. J Am Geriatr Soc 33:278–285
Rowe JW, Andres R, Tobin JD et al (1976) The effect of age on creatinine clearance in men: a cross-sectional and longitudinal study. J Gerontol 31:155–163
Zhou XJ, Rakheja D, Yu X et al (2008) The aging kidney. Kidney Int 74:710–720
Schlanger LE, Bailey JL, Sands JM (2010) Electrolytes in the aging. Adv Chronic Kidney Dis 17:308–319
Cockcroft DW, Gault MH (1976) Prediction of creatinine clearance from serum creatinine. Nephron 16:31–41
Levey AS, Bosch JP, Lewis JB et al (1999) A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 130:461–470
Levey AS, Stevens LA, Schmid CH et al (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150:604–612
Stevens LA, Coresh J, Schmid CH et al (2008) Estimating GFR using serum cystatin C alone and in combination with serum creatinine: a pooled analysis of 3,418 individuals with CKD. Am J Kidney Dis 51:395–406
Stevens LA, Coresh J, Greene T et al (2006) Assessing kidney function–measured and estimated glomerular filtration rate. N Engl J Med 354:2473–2483
Rule AD, Larson TS, Bergstralh EJ et al (2004) Using serum creatinine to estimate glomerular filtration rate: accuracy in good health and in chronic kidney disease. Ann Intern Med 141:929–937
Stevens LA, Manzi J, Levey AS et al (2007) Impact of creatinine calibration on performance of GFR estimating equations in a pooled individual patient database. Am J Kidney Dis 50:21–35
O’Hare AM, Bertenthal D, Covinsky KE et al (2006) Mortality risk stratification in chronic kidney disease: one size for all ages? J Am Soc Nephrol 17:846–853
Randers E, Erlandsen EJ (1999) Serum cystatin C as an endogenous marker of the renal function–a review. Clin Chem Lab Med 37:389–395
Stevens LA, Schmid CH, Greene T et al (2009) Factors other than glomerular filtration rate affect serum cystatin C levels. Kidney Int 75:652–660
Astor BC, Levey AS, Stevens LA et al (2009) Method of glomerular filtration rate estimation affects prediction of mortality risk. J Am Soc Nephrol 20:2214–2222
Shlipak MG, Sarnak MJ, Katz R et al (2005) Cystatin C and the risk of death and cardiovascular events among elderly persons. N Engl J Med 352:2049–2060
Weir MR, Bakris GL (2010) Editorial perspective. Should microalbuminuria ever be considered as a renal endpoint in any clinical trial? Am J Nephrol 31:469–470
Rifkin DE, Katz R, Chonchol M et al (2010) Albuminuria, impaired kidney function and cardiovascular outcomes or mortality in the elderly. Nephrol Dial Transplant 25:1560–1567
Bakris GL (2008) Slowing nephropathy progression: focus on proteinuria reduction. Clin J Am Soc Nephrol 3(Suppl 1):S3–10
National Kidney Foundation (2002) KDOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 30:S1–S2606
Coresh J, Selvin E, Stevens LA et al (2007) Prevalence of chronic kidney disease in the United States. JAMA 298:2038–2047
Hallan SI, Coresh J, Astor BC et al (2006) International comparison of the relationship of chronic kidney disease prevalence and ESRD risk. J Am Soc Nephrol 17:2275–2284
Raymond NT, Zehnder D, Smith SC et al (2007) Elevated relative mortality risk with mild-to-moderate chronic kidney disease decreases with age. Nephrol Dial Transplant 22:3214–3220
Moranne O, Froissart M, Rossert J et al (2009) Timing of onset of CKD-related metabolic complications. J Am Soc Nephrol 20:164–171
O’Hare AM, Choi AI, Bertenthal D et al (2007) Age affects outcomes in chronic kidney disease. J Am Soc Nephrol 18:2758–2765
Shlipak MG, Katz R, Sarnak MJ et al (2006) Cystatin C and prognosis for cardiovascular and kidney outcomes in elderly persons without chronic kidney disease. Ann Intern Med 145:237–246
Tonelli M, Muntner P, Lloyd A et al (2011) Using proteinuria and estimated glomerular filtration rate to classify risk in patients with chronic kidney disease: a cohort study. Ann Intern Med 154:12–21
Stevens LA, Viswanathan G, Weiner DE (2010) Chronic kidney disease and end-stage renal disease in the elderly population: current prevalence, future projections, and clinical significance. Adv Chronic Kidney Dis 17:293–301
Stevens LA, Li S, Wang C et al (2010) Prevalence of CKD and comorbid illness in elderly patients in the United States: results from the Kidney Early Evaluation Program (KEEP). Am J Kidney Dis 55:S23–33
Navaneethan SD, Yehnert H, Moustarah F et al (2009) Weight loss interventions in chronic kidney disease: a systematic review and meta-analysis. Clin J Am Soc Nephrol 4:1565–1574
Wilhelm-Leen ER, Hall YN, Tamura MK et al (2009) Frailty and chronic kidney disease: the Third National Health and Nutrition Evaluation Survey. Am J Med 122(664–671):e662
Kshirsagar AV, Bang H, Bomback AS et al (2008) A simple algorithm to predict incident kidney disease. Arch Intern Med 168:2466–2473
Hippisley-Cox J, Coupland C (2010) Predicting the risk of chronic Kidney Disease in men and women in England and Wales: prospective derivation and external validation of the QKidney Scores. BMC Fam Pract 11:49
Young JH, Klag MJ, Muntner P et al (2002) Blood pressure and decline in kidney function: findings from the Systolic Hypertension in the Elderly Program (SHEP). J Am Soc Nephrol 13:2776–2782
de Zeeuw D, Remuzzi G, Parving HH et al (2004) Albuminuria, a therapeutic target for cardiovascular protection in type 2 diabetic patients with nephropathy. Circulation 110:921–927
Peterson JC, Adler S, Burkart JM et al (1995) Blood pressure control, proteinuria, and the progression of renal disease. The Modification of Diet in Renal Disease Study. Ann Intern Med 123:754–762
Navaneethan SD, Pansini F, Perkovic V et al (2009) HMG CoA reductase inhibitors (statins) for people with chronic kidney disease not requiring dialysis. Cochrane Database Syst Rev 2:CD007784
Baigent C, Landray MJ, Reith C et al (2011) The effects of lowering LDL cholesterol with simvastatin plus ezetimibe in patients with chronic kidney disease (Study of Heart and Renal Protection): a randomised placebo-controlled trial. Lancet 377:2181–2192
Ishani A, Xue JL, Himmelfarb J et al (2009) Acute kidney injury increases risk of ESRD among elderly. J Am Soc Nephrol 20:223–228
Levey AS, Schoolwerth AC, Burrows NR et al (2009) Comprehensive public health strategies for preventing the development, progression, and complications of CKD: report of an expert panel convened by the Centers for Disease Control and Prevention. Am J Kidney Dis 53:522–535
Chobanian AV, Bakris GL, Black HR et al (2003) The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 289:2560–2572
Remuzzi G, Macia M, Ruggenenti P (2006) Prevention and treatment of diabetic renal disease in type 2 diabetes: the BENEDICT study. J Am Soc Nephrol 17:S90–97
Ruggenenti P, Fassi A, Ilieva AP et al (2004) Preventing microalbuminuria in type 2 diabetes. N Engl J Med 351:1941–1951
UK Prospective Diabetes Study Group (1998) Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet 352:837–853
Gerstein HC, Miller ME, Byington RP et al (2008) Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 358:2545–2559
Ismail-Beigi F, Craven T, Banerji MA et al (2010) Effect of intensive treatment of hyperglycaemia on microvascular outcomes in type 2 diabetes: an analysis of the ACCORD randomised trial. Lancet 376:419–430
Patel A, MacMahon S, Chalmers J et al (2008) Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med 358:2560–2572
Duckworth W, Abraira C, Moritz T et al (2009) Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med 360:129–139
Wright JT Jr, Bakris G, Greene T et al (2002) Effect of blood pressure lowering and antihypertensive drug class on progression of hypertensive kidney disease: results from the AASK trial. JAMA 288:2421–2431
Appel LJ, Wright JT Jr, Greene T et al (2010) Intensive blood-pressure control in hypertensive chronic kidney disease. N Engl J Med 363:918–929
Rahman M, Pressel S, Davis BR et al (2005) Renal outcomes in high-risk hypertensive patients treated with an angiotensin-converting enzyme inhibitor or a calcium channel blocker vs a diuretic: a report from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Arch Intern Med 165:936–946
Brenner BM, Cooper ME, de Zeeuw D et al (2001) Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med 345:861–869
Lewis EJ, Hunsicker LG, Clarke WR et al (2001) Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med 345:851–860
Mohamed MA, Weir MR (2009) Renin angiotensin system inhibition in the older person: a review. Clin Geriatr Med 25:245–257
Ajayi AA, Hockings N, Reid JL (1986) Age and the pharmacodynamics of angiotensin converting enzyme inhibitors enalapril and enalaprilat. Br J Clin Pharm 21:349–357
Beckett NS, Peters R, Fletcher AE et al (2008) Treatment of hypertension in patients 80 years of age or older. N Engl J Med 358:1887–1898
Forette F, McClaran J, Delesalle MC et al (1989) Value of angiotensin converting enzyme inhibitors in the elderly: the example of perindopril. Clin Exp Hypertens 11(Suppl 2):587–603
van der Zee S, Baber U, Elmariah S et al (2009) Cardiovascular risk factors in patients with chronic kidney disease. Nat Rev 6:580–589
Manjunath G, Tighiouart H, Coresh J et al (2003) Level of kidney function as a risk factor for cardiovascular outcomes in the elderly. Kidney Int 63:1121–1129
Fried LF, Shlipak MG, Crump C et al (2003) Renal insufficiency as a predictor of cardiovascular outcomes and mortality in elderly individuals. J Am Coll Cardiol 41:1364–1372
Shlipak MG, Katz R, Kestenbaum B et al (2009) Rapid decline of kidney function increases cardiovascular risk in the elderly. J Am Soc Nephrol 20:2625–2630
Sarnak MJ, Levey AS, Schoolwerth AC et al (2003) Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Circulation 108:2154–2169
Hallan S, Astor B, Romundstad S et al (2007) Association of kidney function and albuminuria with cardiovascular mortality in older vs younger individuals: The HUNT II Study. Arch Intern Med 167:2490–2496
Murray AM (2008) Cognitive impairment in the aging dialysis and chronic kidney disease populations: an occult burden. Adv Chronic Kidney Dis 15:123–132
Weiner DE, Bartolomei K, Scott T et al (2009) Albuminuria, cognitive functioning, and white matter hyperintensities in homebound elders. Am J Kidney Dis 53:438–447
Brady CB, Gaziano JM, Cxypoliski RA et al (2009) Homocysteine lowering and cognition in CKD: the Veterans Affairs homocysteine study. Am J Kidney Dis 54:440–449
Odden MC, Chertow GM, Fried LF et al (2006) Cystatin C and measures of physical function in elderly adults: the Health, Aging, and Body Composition (HABC) Study. Am J Epidemiol 164:1180–1189
Fried LF, Lee JS, Shlipak M et al (2006) Chronic kidney disease and functional limitation in older people: health, aging and body composition study. J Am Geriatr Soc 54:750–756
Kurella Tamura M, Covinsky KE, Chertow GM et al (2009) Functional status of elderly adults before and after initiation of dialysis. N Engl J Med 361:1539–1547
Kansal S, Fried L (2010) Bone disease in elderly individuals with CKD. Adv Chronic Kidney Dis 17:e41–51
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Andersen, S., Fried, L. (2012). Chronic Kidney Disease. In: Newman, A., Cauley, J. (eds) The Epidemiology of Aging. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-5061-6_27
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