J Korean Med Assoc.  2007 Jun;50(6):549-555. 10.5124/jkma.2007.50.6.549.

The Chronic Kidney Disease in Elderly Population

• Chin HJ

• KMID: 2184864
• DOI: http://doi.org/10.5124/jkma.2007.50.6.549

Abstract

Chronic kidney disease (CKD) is an important problem in the elderly as well as in general population. The CKD is defined either by a glomerular filtration rate (GFR) of less than 60 ml/min/1.73m(2) BSA or by the presence of kidney damage, assessed most commonly by the finding of albuminuria for three or more consecutive months. The severity of CKD can be classified as follows : stage 1, kidney damage with a normal or increased GFR (more than 90ml/min/1.73m(2) BSA); stage 2, kidney damage with a mild decrease in GFR (89 to 60ml/min/1.73m(2) BSA) ; stage 3, a moderate decrease in GFR (59 to 30ml/min/1.73m(2) BSA); stage 4, a severe decrease in GFR (15 to 29ml/min/1.73m(2) BSA); stage 5, kidney failure (i.e., a GFR of less than 15 ml/min/1.73m(2) or conditions requiring dialysis). The CKD in elderly population is closely related with a high risk of cardiovascular disease, cognitive impairment, functional limitation, and death. We now have to assess the risk among the elderly patients with CKD for the prevention of morbidity and mortality. Clinicians should measure albuminuria and estimate GFR from serum creatinine to detect CKD. Patients with CKD should be evaluated appropriately and treated according to the underlying cause of CKD. Moreover, the medical society should make an effort to inform individuals with increased risk to develop CKD and the necessity of simple diagnostic tests for CKD.

Keyword

Chronic kidney disease; Elderly; Early diagnosis

MeSH Terms

Aged*
Albuminuria
Cardiovascular Diseases
Creatinine
Diagnostic Tests, Routine
Early Diagnosis
Glomerular Filtration Rate
Humans
Kidney
Mortality
Renal Insufficiency
Renal Insufficiency, Chronic*
Societies, Medical
Creatinine

Reference

1. Coresh J, Byrd-Holt D, Astor BC, Briggs JP, Eggers PW, Lacher DA, Hostetter TH. Chronic kidney disease awareness, prevalence, and trends among U.S. adults, 1999 to 2000. J Am Soc Nephrol. 2005. 16:180–188.

2. Coresh J, Astor BC, Greene T, Eknoyan G, Levey AS. Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey. Am J Kidney Dis. 2003. 41:1–12.

3. Hunsicker LG. The consequences and costs of chronic kidney disease before ESRD. J Am Soc Nephrol. 2004. 15:1363–1364.

4. Chadban SJ, Briganti EM, Kerr PG, Dunstan DW, Welborn TA, Zimmet PZ, Atkins RC. Prevalence of kidney damage in Australian adults: The AusDiab Kidney Study. J Am Soc Nephrol. 2003. 14:S131–S138.

5. Korean Society of Nephrology. ESRD Registry Committee. Renal replacement therapy in Korea -Insan memorial dialysis registry 2005-. Korean J Nephrol. 2006. 25:S 2. S425–S457.

6. Stevens LA, Levey AS. Chronic kidney disease in the elderly-How to assess risk. N Engl J Med. 2005. 352:2122–2124.

7. Chin HJ, Oh KW, Oh YK, Na KY, Joo KW, Lim CS, Kim YS, Chae DW, Ahn C, Han JS, Lee JS, Kim S. The prevalence and the associated disorders of chronic kidney disease in subjects with health check-up. Korean J Nephrol. 2007. 27:In press.

8. Kurella M, Chertow GM, Fried LF, Cummings SR, Harris T, Simonsick E, Satterfield S, Ayonayon H, Yaffe K. Chronic kidney disease and cognitive impairment in the elderly: The health, aging, and body composition study. J Am Soc Nephrol. 2005. 16:2127–2133.

9. Fired LF, Lee JS, Shlipak M, Chertow GM, Green C, Ding J, Harris T, Newman AB, Aging and. Chronic kidney disease and functional limitation in older people: Health, Aging and Body Composition Study. J Am Geriatr Soc. 2006. 54:750–756.

10. John R, Webb M, Young A, Stevens PE. Unreferred chronic kidney disease: A longitudinal study. Am J Kidney Dis. 2004. 43:825–835.

11. Obrador GT, Ruthazer R, Arora P, Kausz AT, Pereira BJG. Prevalence of and factors associated with suboptimal care before initiation of dialysis in the United States. J Am Soc Nephrol. 1999. 10:1793–1800.

12. Cirillo M, Laurenzi M, Mancini M, Zanchetti A, Lombardi C, Santo NGD. Low glomerular filtration in the population: Prevalence, associated disorders, and awareness. Kidney Int. 2006. 70:800–806.

13. K/DOQI clinical guidelines for chronic kidney disease: evaluation, classification and stratification. Am J Kidney Dis. 2002. 39:S2. S2–S246.

14. Go AS, Chertow GM, Fan D, McCulloch CE, Hsu C. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004. 351:1296–1305.

15. Madan P, Kalra OP, Agarwal S, Tandon OP. Cognitive impairment in chronic kidney disease. Nephrol Dial Transplant. 2007. 22:440–444.

16. Hostetter TH. Chronic kidney disease predicts cardiovascular disease. N Engl J Med. 2004. 351:1344–1346.

17. Anavekar NS, McMurray JJ, Velazquez EJ, Solomon SD, Kober L, Rouleau JL, White HD, Nordlander R, Maqqioni A, Dickstein K, Zelenkofske S, Leimberger JD, Califf RM, Pfeffer MA. Relation between renal dysfunction and cardiovascular outcomes after myocardial infarction. N Engl J Med. 2004. 351:1285–1295.

18. Bleyer AJ, Shemansk LR, Burke GL, Hansen KJ, Appel RG. Tobacco, hypertension, and vascular disease: risk factor for renal functional decline in an older population. Kidney Int. 2000. 57:2072–2079.

19. Domrongkitchaiporn S, Sritara P, Kitiyakara C, Stitchantrakul W, Krittaphol V, Lolekha P, Cheepudomwit S, Yipintsoi T. Risk factors for development of decreased kidney function in a southeast Asian population: A 12-year cohort study. J Am Soc Nephrol. 2005. 16:791–799.

20. Neugarten J, Acharya A, Silbiger SR. Effect of gender on the progression of nondiabetic renal disease: A meta-analysis. J Am Soc Nephrol. 2000. 11:319–329.

21. Perneger TV, Whelton PK, Klag MJ. Race and end-stage renal disease. Socioeconomic status and access to health care as mediating factors. Arch Intern Med. 1995. 155:1201–1208.

22. Orth SR, Ritz E, Schrier RW. The renal risks of smoking. Kidney Int. 1997. 51:1669–1677.

23. Fried LF, Orchard TJ, Kasiske BL. Effect of lipid reduction on the progression of renal disease: A meta-analysis. Kidney Int. 2001. 59:260–269.

24. Luke RG. Hypertensive nephrosclerosis: pathogenesis and prevalence. Essential hypertension is an important cause of end-stage renal disease. Nephrol Dial Transplant. 1999. 14:2271–2278.

25. Zucchelli P, Zuccala A. The kidney as a victim of essential hypertension. J Nephrol. 1997. 10:203–206.

26. Goetz FC, Jacobs DR Jr, Chavers B, Roel J, Yelle M, Sparafka JM. Risk factors for kidney damage in the adult population of Wadena, Minnesota: A prospective study. Am J Epidemiol. 1997. 145:91–102.

27. Rodriguez-Puyol D. The aging kidney. Kidney Int. 1998. 54:2247–2265.

28. Frocht A, Fillit H. Renal disease in the geriatric patient. J Am Geriatr Soc. 1984. 32:28–43.

29. Silva FG. The aging kidney: A review-Part I. Intern Urol Nephrol. 2005. 37:185–205.

30. Tauchi H, Tsuboi K, Okutomi J. Age changes in the human kidney of the different races. Gerontologia(Basel). 1971. 17:87–97.

31. McLachlan MSF. The aging kidney. Lancet. 1978. 2:143–145.

32. Goyal VK. Changes with age in the human kidney. Exp Gerontol. 1982. 17:321–331.

33. Kaplan C, Pasternack B, Shah H, Gallo G. Age-related incidence of sclerotic glomeruli in human kidneys. Am J Pathol. 1975. 80:227–234.

34. Kappel B, Olsen S. Cortical interstitial tissue and sclerosed glomeruli in the normal human kidney, related to age and sex. Virchows Arch (A). 1980. 387:271–277.

35. Epsein M. Aging and the kidney. J Am Soc Nephrol. 1996. 7:1106.

36. Fliser D, Zeier M, Nowack R, Ritz E. Renal functional reserve in healthy elderly subjects. J Am Soc Nephrol. 1993. 3:1371–1377.

37. Lindeman RD, Tobin J, Shock NW. Longitudinal studies on the rate of decline in renal function with age. J Am Geriatr Soc. 1985. 33:278–285.

38. Tiao JY, Semmens JB, Masarei JR, Lawrence-Brown MM. The effect of age on serum creatinine levels in an aging population. Relevance to vascular surgery. Cardiovasc Surg. 2002. 10:445–451.

39. Hajjar I, Kotchen T. Trends in prevalence, awareness, treatment, and control of hypertension in United States, 1988-2000. JAMA. 2003. 290:199–206.

40. Chin HJ, Na KY, Kim YS, Chae DW, Kim S. The impact of uric acid and metabolic syndrome on the hypertensive incidence in Korean population. Korean J Med. 2007. 7:In press.

41. Silva FG. The aging kidney: A review-Part II. Intern Urol Nephrol. 2005. 37:419–432.

42. Kurella M, Chertow GM, Luan J, Yaffe K. Cognitive impairment in chronic kidney disease. J Am Geriatr Soc. 2004. 52:1863–1869.

43. Feest TG, Mistry CD, Grimes DS, Mallick NP. Incidence of advanced chronic renal failure and the need for end stage renal replacement. BMJ. 1990. 301:897–900.

44. Latos DL. Chronic dialysis in patients over age 65. J Am Soc Nephrol. 1996. 7:637–646.

45. National Kidney Foundation. http://www.kidney.org/news/newsroom/newsitem.cfm?id=54.

46. National Kidney Foundation. http://www.kidney.org/professionals/kdoqi/gfr_calculator.cfm.