The elderly patient with chronic kidney disease

The elderly are a fast growing population in the United States, and they have a high prevalence of chronic kidney disease. The elderly are particularly susceptible to kidney damage from age-related declines in glomerular filtration as well as kidney damage from chronic disease states such as diabetes mellitus, hypertension, glomerular, and tubulointerstitial disorders. A significant number of elderly individuals are reaching end-stage renal disease that require renal replacement therapy. This expanding population provides a challenge for health-care providers because the elderly are often referred late to a nephrologist, have a shortened survival on renal replacement therapy as compared with younger individuals, and suffer from more comorbidities such as cardiovascular disease, malnutrition, and hearing and visual disabilities. The elderly also have difficulties with dialysis vascular access and often are not candidates for renal transplantation. Despite these obstacles, age alone is not a justification for withholding diagnostic or therapeutic interventions, because many elderly individuals have an improvement in their quality of life and social support once their kidney disease is identified and treated. (C) 2005 by the National Kidney Foundation, Inc.