Keep the Kidneys Functioning Till the End: Chronic Kidney Disease in the Older Population

With population ageing and increasing life expectancy, the prevalence of chronic kidney disease (CKD) is rising. In addition to its associated cardiovascular risk, CKD in older people have increased prevalence of geriatric syndromes such as cognitive and functional decline, leading to frailty and disability. Clinical trials evaluating treatment for CKD have usually excluded patients older than 70 years, making it difficult to translate current therapeutic recommendation to the older population. Available evidence suggests that patients over 75 years of age with CKD in the presence of multiple comorbidities have greatly reduced life expectancy and quality of life, even if they choose to have renal replacement therapy. Therefore offering a conservative approach to management supported by palliative care is a more reasonable option for some patients. Kidney transplantation can lead to better life expectancy and quality of life in older people if selected carefully. There is a need for the inclusion of older people in future CKD trials so that evidence-based therapies can be offered to this group.

Keywords: Albuminuria, Creatinine, Chronic kidney disease, Dialysis, End-stage kidney disease, Geriatric syndromes, Glomerular filtration rate, Kidney transplantation, Palliative care, Renal replacement therapy.