Skip to main content

Chronic Kidney Disease in the Elderly

  • Living reference work entry
  • First Online:
Geriatric Diseases

Abstract

Chronic kidney disease (CKD) is characterized by a gradual and progressive loss of renal function resulting in permanent renal failure. The review provides an overview of chronic kidney disease, the clinical manifestations, complications and clinical management. CKD is a progressive disease. Hypertension, intraglomerular pressure, proteinuria and renal damage are interrelated in the background of CKD progression. Renal failure is assessed by the GFR as serum creatinine is a poor indicator of renal failure and one of the reasons being creatinine production is related to the muscle mass. In the elderly, nephrosclerosis, diabetes, obstructive uropathy, polycystic disease and glomerular disease cause renal failure. Chronic renal disease is a significant problem in the elderly and is associated with a high risk of renal failure and death. The aim of treatment is to control symptoms, reduce complications and slow the progression of the disease. Important diagnostic considerations are exclusion of potentially reversible causes such as urinary tract obstruction, the use of nephrotoxic agents and renal artery occlusion. Patients with CKD have a greater risk of dying of cardiovascular disease than progression to end-stage renal disease (ESRD), and there is a close relationship between heart failure and CKD.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Institutional subscriptions

References

  1. Levey AS, Eckardt KU, Tsukamoto Y, Levin A, Coresh J, Rossert J, et al. Definition Classification of chronic kidney disease: a positive statement from Kidney Disease. Improving global outcomes (KDIGO). Kidney Int. 2005;67(6):2089–100.99

    Article  PubMed  Google Scholar 

  2. Arora P, Verrilla M. Chronic renal failure. E-medicine September 2008.

    Google Scholar 

  3. Jungers P, Chearvean P, Descamps-Lakscha B, Labrunie M, Giraud E, Man NK, et al. Age and gender related incidence of chronic renal failure in a French urban area: a prospective epidemiological study. Nephrol Dial Transplant. 1996;11: 1542–1546. .

    Article  CAS  PubMed  Google Scholar 

  4. Molzahan M Future evolution of the ESRD patient population – a perspective for the year 2000. Nephrol Dial Transplant. 1996;11 suppl 8:59–62.

    Article  Google Scholar 

  5. Lopez-Novoa JM, Msarinez-Salgado C, Rodriguez-Pena, Hernandez FJL. Common pathophysiological mechanisms of chronic kidney disease: Therapeutic perspectives. Pharmacol Thera. 2010;128:61–81.

    Article  CAS  Google Scholar 

  6. Klag J, Wheton PK, Randall BL, Neaton JD, Brncati FL, Ford CE, et al. Blood pressure and end stage disease in men. NEJM. 1990;334–18.

    Google Scholar 

  7. Staples A, Wong C. Risk factors for progression of chronic kidney failure. Curr Oin Pediatr. 2010;22(2):161–169.

    Article  Google Scholar 

  8. Locatelli F, Marcelli D, Comelli M, Albert D, Graziani G, Buccinanti G, et al. Proteinuria and blood pressure is causal components of progress to end stage renal failure. Northern Italian Cooperative Study Group .Nephrol Dial Transplant. 1996;11(3):461–7.

    Article  CAS  PubMed  Google Scholar 

  9. Wuhl E, Schaefer F. Managing kidney disease with blood pressure control: Pathophysiology of CKD progression. Medscape. http://www.medscap.org/viewarticle/744528_3 retreived 2/07/2013

  10. Peterson JC, Adler S, Burkart JM, Greene T, Herbert LA, Hunsicker LG, et al. Blood pressure control, proteinuria and the progression of renal disease. The Modification of Diet in Renal Disease Study. Ann Inter Med. 1995;123:754–762.

    Article  CAS  Google Scholar 

  11. Jafar TH, et al. Angiotensin converting enzyme inhibits progression of non diabetic renal disease. A meta-analysis of patient level data. Am Intern Med. 2001;138:73–37.

    Article  Google Scholar 

  12. Ruggenenti P, Echieppati A, Remuzzi G. Progression, remission, regression in chronic renal diseases Lancet. 2001;357:1601–8.

    Article  CAS  PubMed  Google Scholar 

  13. National Kidney Foundation.K/DOQI. Clinical practice guidelines for chronic kidney disease: evaluation and stratification. Am J Kidney Dis. 2002;39(2):S1–266.

    Article  Google Scholar 

  14. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. 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. 1999;130:461–70.

    Article  CAS  PubMed  Google Scholar 

  15. Perkins BA, Ficociello LH Ostrander BE. Microalbuminuria and risk of early progressive renal function. Decline in Type 1 diabetes. J Am Soc Nephrol. 2007;18: 1353–1361.

    Article  CAS  PubMed  Google Scholar 

  16. http://www.nursingcenter.com/prodev/ce_article.asp?tid+=587028 [113].accessed on 12/9/08.

  17. Collins AJ, Li S, Gilberton DT, Liu J, Chen SG, Herzog CA. Chronic kidney disease and cardiovascular disease in the medicare population. Kidney Int .Suppl 2003;87:S24–31.

    Article  Google Scholar 

  18. Guy J, Johnston PK, Corbett JJ, Day AL, Glaser JS. Treatment of visual loss in pseudo tumour cerebri associated with uraemia. Neurology. 1990;40(1):28–52.

    Article  CAS  PubMed  Google Scholar 

  19. Brouns R, De Deyn P. Neurological complications in renal failure: a review. Clin Neur Neurosurg. 2003;107:1–16 .

    Google Scholar 

  20. Krishnan AV, Kiernan GC. Neurological complications of chronic kidney disease. Nat Rev Neurol. 2009;83: 542–551.

    Article  Google Scholar 

  21. Galassi G, Ferrari S, Cobelli M, Rizzuto. Neuromuscular complications of kidney disease. Nephrol Dial Transplant. 1998;13(Suppl7):41–7.

    Article  PubMed  Google Scholar 

  22. Dumitri D, Amata A, Zwarb B. Electrodiagnostic Medicine. Philadelphia: Hanley and Belfris. 2002 pp 984–986.

    Google Scholar 

  23. Garcia S, Cofan F, Combalie A, et al. Compression of the ulnar nerve in Guyon’s canal by uraemic tumoral calcinosis. Arch Orthop Trauma Surg. 2000;120(3/4):228–330.

    CAS  PubMed  Google Scholar 

  24. Campistol JM. Uraemic myopathy. Kidney Int. 2002;62:1901–12.

    Article  PubMed  Google Scholar 

  25. Martin KJ, Gonzalez EA. Metabolic Bone Disease in Chronic Kidney Disease. JASN. 2007;18(3):875–885.

    Article  CAS  PubMed  Google Scholar 

  26. Blaine J, Chonchol M, Levi M. Renal control of calcium phosphorus and magnesium homeostasis. Clin J Am Soc Nephrol. Doi: 10.2215/CJN.09750913.

  27. Lips P. Vitamin D deficiency and secondary hyperparathyroidism in the elderly: Conequences for bone loss and fractures and therapeutic implications. Endocrin Rev. 2011;22(4): http://press.enocrine.org/doi/full/10.1210/edrv.22.4.0437.

  28. Mohammed IA, Hutchinson AJ. Phosphate binding therapy in dialysis patients: focus on lanthanum carbonate. Ther Clin Risk Manag. 2008;4(5);887–893.

    CAS  PubMed  PubMed Central  Google Scholar 

  29. Kalantar-Zadeh K, Klein M, Dunne E, Ahem K, Nelson M, Koslowe R, et al. Total iron binding capacity estimated transferring correlates with nutritional subjective global assessment in haemodialysis patients. Am J Kidney Dis. 1998;31(2);263–72.

    Article  CAS  PubMed  Google Scholar 

  30. Kidney Health Australia. Chronic kidney disease (CKD) management in general practice.www.kidney.org.au.

  31. Barclay L, Murata P. Guidelines for drug dosing regimes n chronic kidney disease. Medscape. May 29,2007.http://ww.medscape.org/viewarticle/557381 accessed on 22 May 2016.

  32. Brown JB, Pedula MS, Barzilay J, Herson MK, Latare P. Lactic acidosis in type2 diabetes. Diabetes Care. 1998;21:1659–1663.

    Article  CAS  PubMed  Google Scholar 

  33. Harrington AVG, Levy JB. Metformin :effective and safe in renal disease. Int Urol Nephrol 2008;40:411–417.

    Article  Google Scholar 

  34. Jones GC, Macklin JP, Alexander WD. Editorial. BMJ 2003;326:4–5

    Google Scholar 

  35. Johnson DW, Mathew T. Managing chronic kidney disease. Med Today 2007; 8:37–45.

    Google Scholar 

  36. NKF KDOQI Guidelines. www2.kidney.org/professionals/kdoqi;guidelines_bp/guide_11.html.

  37. Barkris GL, Sarafidis PA, Weir MR, Dahiof B, Pitt B, Jamerson K, et al. Renal outcomes of different fixed dose combination therapies in patients with hypertension at high risk for cardiovascular events (ACCOMPLISH): a prespecified secondary analysis of a randomised controlled trial. Lancet 2010;375(9721):1173–81.

    Article  Google Scholar 

  38. Andreucci VE, Fuiano G, Russo D, Andreucci M. Vasomotor nephropathy in the elderly. Nephrol Dial Trans plant. 1998;13(7):17–24.

    Article  Google Scholar 

  39. Dixit M, Doan T, Kirschner R, Dixit N. Significant AKI due to non-steroidal anti inflammatory drugs: In patients setting. Phamaceuticals. 2010;3;1279–1285.

    Article  CAS  Google Scholar 

  40. Coyne DW. Ferumoxytol for treatment of iron deficiency anaemia in patients with chronic kidney disease. Expert Opin Pharmacother. 2009;10(15):2563–8.

    Article  CAS  PubMed  Google Scholar 

  41. Rosner MH, Bolton WK. Ferumoxytol for treatment of anaemia in chronic kidney disease. Drugs Today. (Barc) 2009;45(11):779–89.

    Article  Google Scholar 

  42. McCormack PL. Ferumoxytol in iron deficiency anaemia in adults with chronic kidney disease. Drugs. 2012;72(15):2013–22 .

    Article  CAS  PubMed  Google Scholar 

  43. Schwenk WH. Ferumoxytol: a new intravenous iron preparation for treatment of iron deficiency in patients with chronic kidney disease. Phamacotherapy. 2010;30(1):70–9.

    Article  CAS  Google Scholar 

  44. Longhnan A, Ali GR, Abeygunasekera SC. Comparison of the therapeutic efficacy of epoetin beta and epoetin alfa in maintenance phase haemodialysis patients. Renal Failure. 2011;33(3):373–5.

    Article  Google Scholar 

  45. Phrommintikul A, Haas SJ, Elsik M, Krum H. Mortality and target haemoglobin concentrations in anaemic patients with chronic kidney disease treated with erythropoietin: a meta-analysis. Lancet. 2007;369:381–8.

    Article  CAS  PubMed  Google Scholar 

  46. Lankhorst CE, Wish JB. Anaemia in renal disease. Diagnosis and management. Blood Rev. 2010;24:39–47 .

    Article  CAS  PubMed  Google Scholar 

  47. MacGinley RJ, Walker RG. International treatment guidelines for anaemia in chronic kidney disease-what has changed?. Editorial. MJA. 2013;199(2):84.

    Google Scholar 

  48. Chertow GH, Burke SK, Dilion MA, Slatopolsky E. Long term effects of sevelamer hydrochloride on calcium and phosphate product and upon profile of haemodialysis patients. Nephrol Dial Transplant. 2000;15:559–576.9

    Article  CAS  PubMed  Google Scholar 

  49. Tan K-S, Johnson DW. Managing the cardiovascular complications of chronic kidney disease. Aust Prescriber. 2008;8:154–158.

    Article  Google Scholar 

  50. Kausz A, Pihari D. The value of vaccination in chronic kidney disease. Seminars in Dialysis. Vol 17 pages 9–11, 2004. published on-line.

    Article  PubMed  Google Scholar 

  51. Kausz A, Gilbertson D. Overview of vaccination in chronic kidney disease. Advance in Chronic Kidney Disease. 2009;13:209–214.

    Article  Google Scholar 

  52. Johnson DW, Fleming ST. The use of vaccines in renal failure. Clin Pharmacokinet. 1992;22:434–446.

    Article  CAS  PubMed  Google Scholar 

  53. James N, Vacher L-V, Karie S, Ledneva E, Deray G. Vaccinations and chronic kidney disease. Nephrol Dial and Trans. 2008;23(3):800–807.

    Google Scholar 

  54. O’Hare AM, Bertenthal D, Covinsky KF, Landefeld CS, Sen S, Mehta K, et al. Mortality risk stratification in chronic kidney disease. One size for all ages? J Am Soc Nephrol. 2006;17:846–853.

    Article  PubMed  Google Scholar 

  55. Garo AX, Papaioannou A, Ferko N, Campbell G, Clarke IA, Ray IG. Estimating the prevalence of renal insufficiency in seniors requiring long-term care. Kidney Int. 2004;65:649–653.

    Article  Google Scholar 

  56. Davison SN. Chronic kidney disease: psychological impact of chronic pain. Geriatrics. 2007;62(2):17–23.

    PubMed  Google Scholar 

  57. Hwang S-JVH, Tsai J-C, Chen H-C. Epidemiology impact and preventive care of chronic kidney disease inTaiwan. Nephrology. 2010;15:3–9.

    Article  PubMed  Google Scholar 

  58. Shiba N, Shimokawa H. Chronic kidney disease and heart failure-Biochemical close link and common therapeutic goal. J Cardiol. 2011;57(1):8–179.

    Article  PubMed  Google Scholar 

  59. Anand S, Johansen KL, Tamura MK. Aging and chronic kidney disease: the impact on physical function and cognition. J Gerontol A Biol Sci Med Sci. 2014;69A(3):315–322. Doi: 10.1093/Gerona/glt109.

    Article  Google Scholar 

  60. Zalai D, Szeifert L, Novsak M. Psychological distress and depression in patients with chronic kidney disease. Semin Dial. 2012;25(4):428–38 .

    Article  PubMed  Google Scholar 

  61. Belayev LY, Mor MK, Sevick MA, Shields AM, Rollman BL, Palevsky PM, et al. Longitudinal associations of depressive symptoms and pain with quality of life in patients receiving chronic haemodialysis. Hemodial Int. 2015;19(2):216–24 .

    Article  PubMed  Google Scholar 

  62. Valderrabano F, Jofre R, Lopez Gomez JM. Quality of life in end-stage renal disease patients. Am J Kidney. Dis. 2001;38(3):443–64.

    Article  CAS  PubMed  Google Scholar 

  63. Bowling CB, Sawyer P, Campbell RC, Ahmed A, Allman RM. Impact of chronic kidney disease on activities of daily living in community dwelling older adults. J Gerontol A Bio Sci Med Sci. 2011;66(A96):698–694.

    Google Scholar 

  64. Fried LF, Lee JS, Shipak M, Cherton CM, Green C, Ding J, et al. Chronic kidney disease and functional limitation in older people; and body composition study. J Am Geriatr Soc 2006;54(5):750–6.

    Article  PubMed  Google Scholar 

  65. Shih C-J, Chen Y-T, Ou S-M, Yang W-C, Kuo S-C, Tarng D-c. and for the Taiwan Geriatric Kidney Disease Research (TGKD) Group. BMC Medicine. 2014;12:169 doi:10.1186/s12916-014-0169-3.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Moss AH. Revised dialysis clinical practice guideline promotes more informed decision-making. Clin J AM Soc Nephrol. 2010;5:2380–2383.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Nages Nagaratnam .

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this entry

Cite this entry

Nagaratnam, N., Nagaratnam, K., Cheuk, G. (2017). Chronic Kidney Disease in the Elderly. In: Geriatric Diseases. Springer, Cham. https://doi.org/10.1007/978-3-319-32700-6_31-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-32700-6_31-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-32700-6

  • Online ISBN: 978-3-319-32700-6

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics