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Essential Tips for Geriatric Kidney Health: Stay Healthy

Essential Tips for Geriatric Kidney Health: Stay Healthy

Geriatric Kidney Health

1. Introduction

Elderly people are more vulnerable to chronic kidney disease (CKD) and its complications, such as renal failure, due to the body's natural aging process. As the age increases, the structural and overall functioning of the kidney decreases. Maintaining kidney health is very essential in older people as the kidneys perform many important functions. Kidney-related diseases are more common in older age as compared to adults.

With increasing age, the size of kidneys decreases by weight and volume. The normal weight of kidneys is 245-290g, but it decreases 15-20% and remains 180-200g by the age of 90. The decreased kidney functions result in chronic renal conditions, impaired quality of life, increased risk of heart diseases and lower survival rate.

The Australian Bureau of Statistics (ABS) and the Australian Institute of Health and Welfare (AIHW) highlighted that the prevalence of kidney diseases increases with age. The percentage of Australians aged 65–74 with chronic kidney disease (CKD) was three times higher than those aged 55–64 years.

2. Types of Age-Related Kidney Disease

There are different types of age-related kidney diseases. The most commonly observed in elderly adults are chronic kidney disease (CKD), end-stage kidney disease (ESKD) and acute kidney injury (AKI).

age related kidney disease

Chronic kidney disease (CKD): 

Chronic kidney disease is most commonly observed in older people. It is a gradual and progressive decline in kidney functions that takes years to develop. It is commonly caused by prolonged complications such as diabetes and hypertension. The NIH reported the severity of CKD affects 8% to 16% of the population worldwide.

End-Stage Kidney Disease (ESKD): 

End-stage kidney disease is the last stage of chronic kidney disease, also known as renal failure. Doctors treat it only with dialysis or kidney transplants. The elderly population above 65 years shows a high prevalence of ESKD.

Acute Kidney Injury (AKI): 

AKI is a temporary loss of kidney functions caused by severe dehydration, infection, medicines, or surgery. It is reversible, but negligence in treatment leads to chronic conditions like renal failure. AKI is more common in elderly adults than in the younger generation due to lower immunity and increased risk of infection. It is a short-term condition that causes electrolyte imbalances and fluid overload.

The NHS shared a case study of an elderly patient with AKI caused by factors like blood loss or dehydration. The patient was treated with timely fluid, and impaired kidney function back to normal.

The NIH also highlighted the results of recent research showing the prevalence of CKD in older patients with Type 2 diabetes mellitus is 59.5%.

3. Causes of Kidney Dysfunction in Older Adults

Some risk factors contribute to kidney disease even in older age. It includes 

  • High blood pressure
  • Uncontrolled diabetes
  • Obesity
  • Family history of kidney failure
  • Smoking
  • Recurrent UTI infections
  • Kidney stones
  • Excessive use of painkillers such as NSAIDs. 

 

casuses of kieny diseases in aged people

 

Primary Causes of Kidney Diseases in Older Adults:

Among the above risk factors, diabetes and hypertension are the most common cause of kidney disease in older age.

  • Diabetes: Diabetes, especially type 2 diabetes, is the leading cause of kidney failure. Over time, high blood sugar levels damage the kidneys' filtering units. When kidneys become damaged, they are unable to perform their functions and filter blood and excess waste. This results in the appearance of symptoms such as albuminuria (protein) in the urine.
  • High Blood Pressure: Consistent high blood pressure narrows the blood vessels and reduces kidney blood flow. It damages the kidneys' filtering unit and causes kidney diseases in older people.
  • Atherosclerosis is another risk factor for kidney disease that contributes to clot formation in arteries and restricts blood flow to the kidneys. It is termed ischemic nephropathy, which causes the hardening of arteries and results in kidney failure. It is more common in older adults due to the natural ageing of blood vessels.

Lifestyle Factors Contributing to Kidney Dysfunctioning

Some lifestyle factors also contribute to kidney dysfunction in older age people. It includes poor diet, lack of physical activity, smoking, obesity and excessive use of painkillers such as NSAIDs.

  • Poor intake of nutrients: A diet low in protein can lead to protein-energy wasting and result in kidney disease in older people. It is more common in older adults and results in CKD. However, a diet higher in animal protein from meat and dairy products also causes kidney damage, as it is difficult to metabolise and increases the workload and pressure on the kidneys, damaging the filtering units of the kidneys.
  • Lack of Physical Activity: Physical inactivity increases the risk of developing chronic kidney disease in older people. The NIH highlighted that exercise improves blood pressure and insulin resistance, preserves renal function, and lowers the risk of CVD. It is a modifiable factor and can be enhanced to reduce the risk of kidney diseases in the elderly.
  • Smoking: It is another risk factor for kidney disease.  Smoking lowers the blood flow of the kidneys and damages its filtering units. Excessive smoking increases the risk of heart disease, CVD, stroke and renal cancer. Smoking is dangerous to all age groups but older people are at higher risk of renal failure due to lower recovery capacity, declined kidney functioning, increased inflammation or other diseases such as diabetes and hypertension.
  • Obesity: It increases the risk of kidney diseases by increasing blood pressure and glucose. It directly damages the kidneys by producing cytokines that are toxic to organs. Obesity also increases the amount of oxalates and uric acid that may cause kidney stones.
  • Excessive use of Medicines: Excessive use of medicines such as NSAIDs damages kidneys over time and causes kidney failure.

Genetic predispositions and their impact.

Genetics and family history also play a key role in increasing the risk of kidney disease. Genetic mutations commonly cause kidney diseases due to changes in genes like APOL1, MYH9, HNF1B, and SLC7A9, among others. The APOL1 variant, in particular, increases the risk of high blood pressure, leading to conditions such as chronic kidney disease (CKD), focal segmental glomerulosclerosis (FSGS), and HIV-associated nephropathy (HIVAN).

Environmental factors and their role

Certain environmental factors increase the risk of kidney disease in older people. Due to their decreased immunity, older people are more prone to infections and diseases. Mercury, lead exposure, and cadmium from food are some environmental toxins that contribute to kidney disease and affect overall health. These chemicals are more commonly found in fish, especially freshwater fish. 

People working in industries are more prone to exposure to lead toxins from battery recycling and manufacturing processes. In severe cases of lead exposure, it results in gout with kidney disease also termed as saturnine gout with nephropathy. Cadmium increases the risk of kidney diseases. It is present in cigarette smoke and some foods, such as rice grown in soil with cadmium.

The American Kidney Fund (AKF) highlighted that diabetes is the top cause of kidney failure. The American Diabetes Association (ADA) concluded that chronic kidney disease (CKD) affects 1 in 3 adults with diabetes and 1 in 5 adults with hypertension. The complications of CKD increase with age and affect over 38% of people 65 years and above. Research has shown that adjusting lifestyle changes, adopting a balanced diet, regular exercise, and quitting smoking helps to slow the progression of kidney disease.

4. Symptoms of Kidney Disease in the Elderly

These are some symptoms of kidney disease in older adults.

Early Signs of Kidney Disease: 

  • General Fatigue and Tiredness: This is a common symptom in the elderly but not specifically related to kidney disease. The kidney releases the erythropoietin hormone that produces red blood cells. Decreased kidney functioning leads to lower production of RBCs, which causes fatigue and general weakness among older adults.
  • Swelling: Swelling results from fluid retention when the kidneys are unable to excrete waste from the blood. It is mostly observed in the legs, ankles, and feet and is accompanied by puffiness around the eyes. 
  • Changes in urine colour indicate kidney diseases. Blood in the urine, foamy urine, or difficulty urinating are some common symptoms of kidney diseases. 
  • Urinating more frequently: Increased frequency of urination, especially at night, may indicate kidney disease. The increased urge to urinate may be due to damaged kidney filters. Sometimes, this symptom may also indicate an enlarged prostate in males or a urinary tract infection (UTI).

Progressive and Severe Symptoms

  • Shortness of Breath is another symptom of kidney disease caused by fluid accumulation in the lungs. The lower production of RBCs causes anaemia and also results in shortness of breath.
  • Skin Changes:  Kidney diseases cause darker skin or skin itchiness due to the mixing of waste products in the blood.
  • Nausea and Loss of Appetite: Nausea results from a build-up of toxins in the blood that decrease appetite, taste changes, and consistent feelings of nausea.
  • Trouble while concentrating: Severe decline of kidney function results in the buildup of toxins in the blood, which causes weakness or tiredness and difficulty while concentrating. Anaemia may also cause weakness and trouble while concentrating.
  • Cold sensitivity: Kidney disease, caused by anaemia, makes people more cold-sensitive. People with kidney disease feel cold even in warmer environments. 
  • Difficulty Sleeping: When the kidneys are unable to filter blood, waste products remain in the body, making it difficult to sleep at night. People with obesity and chronic kidney disease commonly experience sleep apnea, linking these conditions to each other more frequently than in the general population.
  • Muscle cramping: Improper renal function can lead to electrolyte abnormalities that may also cause low calcium and phosphorus levels.
  • Persistent puffiness around eyes: Urine-containing protein is a warning indication that the kidney filters are damaged. It causes protein to appear in the urine. Kidneys leak a lot of protein into the urine instead of storing it in the body, which could be the cause of the puffiness around the eyes.
  • Increased Blood Pressure: Hypertension can be both a cause and a symptom of kidney disease. The kidneys play an essential role in regulating blood pressure, and when they are not functioning properly, it can lead to higher blood pressure, which in turn can further impair kidney function.

How symptoms differ from the younger population:

In older age, the patient does not show any specific and visible symptoms. This makes the diagnosis more complicated in later stages, and symptoms may be confused with other diseases. For example, fatigue or appetite changes may also indicate an ageing process rather than a sign of kidney disease.  

Moreover, older adults complain of more noticeable swelling due to fluid retention, most commonly observed in the legs due to reduced mobility. They may also face mental confusion or cognitive changes due to toxin accumulation (uremia), which can be confused with dementia or other neurological disorders.

Early detection of kidney disease helps in better recovery than disease diagnosed at later stages. Blood tests (for creatinine and eGFR) and urine tests (for protein levels) are the best ways to detect kidney disease early. It can diagnose any kidney damage even before symptoms appear.

A case study showed a patient of a 64-year-old man with bilateral leg swelling, decreased urine production, appetite loss, severe dyspnoea, and general weakness. He was diagnosed with hypertension for the last three years. His GFR was below 15 mL/min/1.73 m2, indicating stage 5 chronic renal disease and his blood pressure was high upon assessment. He was diagnosed with hypertension and chronic kidney disease. 

Another case study showed an 80-year-old patient with a history of hypertension and visible symptoms of fatigue, leg swelling and nocturia. Blood tests revealed increased creatinine levels, which led to a diagnosis of CKD.

5. Risk Factors for Age-Related Kidney Disease

These are some risk factors for age-related kidney disease.

Genetic Factors: 

Some people may have a family history of kidney disease, which increases their risk of developing kidney disease. Genetic factors can also make older adults more prone to conditions such as polycystic kidney disease or inherited kidney malformations, which negatively affect kidney function.

Lifestyle Factors: 

Lifestyle factors including poor dietary intake also increase the risk of kidney diseases. Smoking decreases blood flow to the kidneys and damages its filter. A poor diet, especially high in sodium and processed foods, also increases the risk to the elderly population. A sedentary lifestyle and insufficient physical activity also increase the risk of hypertension and diabetes, which are leading causes of kidney damage.

Medical History:

Following medical conditions also increases the risk of kidney diseases in older adults.

  • Diabetes: Diabetes is the primary and leading risk factor for kidney disease. Increased blood sugar levels over time damage the kidney filter, nerves, and bladder, causing difficulty emptying the bladder. The pressure harms the kidneys and nephrons. Type 2 diabetes is more common in people over age 40. The National Kidney Foundation (NKF) reported that kidney failure affects about 30% of people with Type 1 diabetes and 10- 40% of people with Type 2 diabetes.
  • High Blood Pressure: Hypertension is another leading risk factor for kidney disease. Increased blood pressure also damages the kidney filters and nephrons. It is a major contributor to kidney disease progression and renal failure. Recent research reported that the prevalence of hypertension among older Irish adults with CKD is high (81.9%).

The Centers for Disease Control and Prevention (CDC) reported that Chronic renal disease affects about 1 in 3 persons with diabetes and 1 in 5 older adults with high blood pressure.

  • Glomerulonephritis: This inflammation of the glomeruli increases the risk of kidney failure in older adults. It is caused by inflammation of the kidney filtering unit that results from infection. Although it is treatable, it damages the kidneys over time and results in kidney failure if left untreated. 
  • Polycystic Kidney Damage is a genetic disease that causes the formation of various fluid-filled cysts. This medical condition also increases the risk of chronic kidney diseases and renal failure in older adults.

6. Lifestyle and Environmental Factors

Impact of Dietary Adjustments and Exercise on Kidney Health:

Consuming kidney-friendly food preserves kidney health and prevents further damage. This includes moderating protein intake, and foods low in sodium, potassium, and phosphorus are kidney-friendly because they decrease kidney load. Experts also recommend the DASH diet (rich in fruits, vegetables, low-fat dairy products, whole grains, fish, poultry, beans, seeds, and nuts), especially for older adults with kidney disease.

Regular exercise and aerobic exercise help maintain kidney function and promote healthy weight and overall health. The NIH recommends continuous activity for 30 minutes, such as walking, swimming, and bicycling, to support kidney health. 

Role of Pollution and Environmental Toxins

Chronic exposure to specific chemicals or poisons is harmful to the kidneys. It includes certain chemicals and industrial toxins that damage the kidneys. The e geriatric population is mostly affected by decreased immunity. Heavy metals such as mercury, cadmium and lead mostly found in seafood such as tuna and freshwater fish, increase the risk of CKD. 

Passive smoking also increases the risk of kidney diseases. Exposure to tobacco smoke is linked with the development of kidney cancer and bladder cancer. Heavy exposure to herbicides and pesticides also raises the risk of CKD, which affects farmers more commonly. 

The National Kidney Foundation (NKF) highlighted research findings showing that about 25–37% of people are at greater risk of developing new kidney disease, 36% are more likely to experience rapid renal function loss, and 31% are more likely to face kidney failure followed by dialysis for every 10 microgrammes of pollution per cubic meter of air.

7. Age-Related Kidney Disease and Heart Health

 

Kidney and heart health are correlated. Both conditions have similar risk factors, such as obesity, hypertension, and diabetes. The kidneys and the heart work together to maintain overall health by regulating blood pressure, removing toxins, and managing fluid balance. 

Age-Related Kidney Disease and Heart Health

How kidney disease affects heart function.

In older adults, cardiovascular health is compromised when the kidneys are unable to perform their function. Damaged kidneys negatively impact cardiovascular function by increasing blood pressure and putting additional strain on the heart due to fluid retention. This condition leads to waste buildup in the blood due to impaired kidneys, which results in vascular calcification and increases the risk of CVD. 

Doctors treat this condition with medicines to manage risk factors, such as controlling blood glucose levels in diabetes and increasing blood pressure levels in hypertension. They also recommend water pills (diuretics) to control blood pressure and insulin injections and medications to control blood glucose levels.

Shared risk factors and preventative measures:

The risk factors for kidney disease and heart disease include hypertension, diabetes, obesity and smoking. These are some preventive ways to manage kidney and heart disease in older adults simultaneously.

  • Consult the doctor to manage the symptoms and complications of the disease.
  • Maintain the blood pressure at normal ranges, i.e., 140/90mm/Hg for older adults.
  • Take a healthy diet and avoid processed and junk foods.
  • Control sugar level up to normal ranges, i.e., 100mg/dL at fasting.
  • Maintain normal cholesterol levels up to less than 200 mg/dL.
  • Maintain a healthy body weight according to normal body mass index (BMI) ranges, i.e., 18.5–24.9 kg/m2.
  • Indulge in any physical activity at least 30 minutes per day and 5 days a week.
  • Take prescribed medicines in a timely to manage further complications.

Importance of Managing Both Conditions

It is important to manage kidney disease and heart health together. The advancement of one condition results in the decline of the other organ. For example, chronic kidney disease (CKD) increases the risk of cardiovascular diseases, while heart failure lowers the blood flow to the kidneys, leading to a decline in kidney function. Healthcare providers recommend a multidisciplinary approach to manage these complications.

 

The NIDDK shared that heart disease is the leading cause of death in people with kidney disease. People with heart disease are likely to develop kidney illness in older adults. 

8. Investigating Kidney Dysfunction in the Elderly

Older adults require careful monitoring to diagnose kidney-related complications. The diagnostic procedures include 

  • Blood Test: Blood and urine tests are common tests to diagnose any kidney dysfunction. Creatinine and GFR values are observed in blood tests. The normal value for GFR is 60 or more. A GFR value less than 15 indicates renal failure, and doctors treat the patient with dialysis or a kidney transplant. The normal creatinine values vary by age, gender and body size. For older adults above 60, the normal creatinine value is 56 to 131 mL/min/BSA.
  • Urine Test: In the urine test, the amount of albumin protein is observed in the excreted urine. The high levels of albumin in the protein indicate kidney damage. Urine tests also observed Urine albumin-to-creatinine ratio (UACR) values to diagnose kidney disease. The normal values of uACR is 30 mg/g or less is normal The uACR values more than 30 mg/g indicates a sign of kidney disease.
  • Imaging Techniques: Imaging techniques play a significant role in diagnosing kidney disease. It includes ultrasound, CT scan, MRI and digital X-ray. 
  • Ultrasound helps to identify any structural abnormality, kidney stones or cysts. In older adults, X-rays can detect kidney size changes or scarring due to any chronic condition. 

CT scan or MRI is effective in identifying tumours, blockages or detailed structural abnormalities of kidneys.

Kidney function tests and markers:

It includes Cystatin C and electrolyte balance tests. Cyastatin C provides a more accurate estimation of kidney functions than creatinine levels. It is more effective for older adults because creatinine levels can be misleading due to muscle loss. Electrolyte balance tests also reveal sodium, potassium, and calcium levels that are already disturbed in older adults with kidney disease.

The National Institute of Health (NIH) recommends annual screening with blood and urine tests necessary for older adults, especially those who are diabetic or hypertensive. It also reported that early diagnosis is effective in delaying the progression of kidney disease or kidney failure in older adults. 

For example, doctors recommend annual screening tests like GFR, ACR, and urinalysis for elderly patients with diabetes to observe any signs of kidney damage. For hypertensive patients, continuous monitoring of blood pressure and kidney function tests is important to prevent chronic kidney disease (CKD).

9. Key Points, Stats, and Comparison

Kidney disease is a serious health condition that affects all age groups and is more commonly seen in older adults. Older adults are more vulnerable to kidney disease due to the ageing process and lower immunity. 

The National Kidney Foundation (NKF) reports that 1 in 3 adults over 65 are at higher risk for chronic kidney disease (CKD) due to hypertension, diabetes, and heart disease. 

Early detection and treatment help manage the complications of CKD and slow its progression, especially in older individuals. The CDC reported that Medicare individuals aged 75 to 79 have a 40% higher odds ratio (OR) of chronic kidney disease (CKD) than those aged 65 to 74. The odds ratio for individuals over 80 is 1.75.

According to USRDS, older adults (65+) account for 43% of new ESKD cases each year, and chronic kidney disease (CKD) affects around 38% of older adults.

Comparisons between age groups and regions.

This table shows the prevalence of kidney disease between different age groups and regions.

Category

Prevalence

Prevalence of CKD by Age

According to the CDC, the prevalence of CKD by age shows

- 65+ years: 38% have CKD

- 45-64 years: 13% have CKD

- 18-44 years: 6% have CKD

ESKD Incidence by Age Group

According to NIDDK, the incidence of ESKD by age group shows

- 65+ years: 43% of ESKD cases

- 45-64 years: 36%

- 18-44 years: 21%

Regional Comparison (U.S.)

According to the CDC, the regional comparison shows

- Northeast: Highest CKD prevalence, 18.7%

- South: 17.9%

- West: 12.9%

CKD and Ethnicity

According to the National Kidney Foundation (NKF),

- Non-Hispanic Blacks: 4x more likely to develop ESKD than Whites

- Hispanics: 2 times more at risk of developing CKD

Global Comparison

According to the CDC,

- High-income countries: CKD rates stable but high healthcare burden

- Low- and middle-income countries: Rising CKD prevalence due to undiagnosed hypertension and diabetes

Impact of kidney disease on healthcare systems

For healthcare systems, there is an increased burden of CKD in older adults that requires long-term care. Regular testing, proper management, and prevention strategies help reduce the complications and symptoms of chronic kidney disease (CKD) on both patients and healthcare resources.

 

Impact of kidney disease on healthcare systems

10. Risk Factors for Progressive CKD

These are some modifiable and non-modifiable risk factors that contribute to the progression of kidney disease.

 

Modifiable Risk Factors

Non-Modifiable Risk Factors

  • Hypertension
  • Diabetes
  • Obesity
  • Proteinuria
  • Hyperlipidemia
  • Cardiovascular Health (CVD)
  • Glomerular and tubulointerstitial disease
  • Metabolic Acidosis
  • Smoking
  • High-protein diet
  • Hyperphosphatemia
  • Hypercalcemia
  • Old age
  • Race/Ethnicity
  • Gender
  • Low birth weight
  • Family history

Modifiable Factors:

The following factors are modifiable and can be controlled through diet, exercise and medications to reduce the risk of CKD in older adults.

  • Hypertension: High blood pressure damages the kidney nephrons and long-term damage can cause the development of chronic kidney disease. The NIH reported that approximately 60% of older adults (60 years of age) who suffer from high blood pressure are at higher risk of developing chronic kidney diseases. Lifestyle changes and medicines can manage this modifiable factor to lower blood pressure and decrease the risk of CKD in older adults.
  • Diabetes: High blood sugar and chronic kidney disease are interlinked and common in older adults. An increased sugar level damages the blood vessels of nephrons prevents blood filtration, and damages the kidney over time. Diabetes is also a modifiable factor that can be controlled through diet, exercise, and medicines.
  • Heart Disease: People with heart disease are at increased risk of CKD due to reduced blood flow to the kidneys. CKD in older adults also increases the risk of heart disease. 
  • Obesity: Being overweight increases the risk of diabetes and hypertension; both are the two biggest causes of CKD. 
  • Proteinuria: Increased protein levels in excreted urine indicate kidney damage. Values above 150mg of protein in the urine are abnormal, and people with higher values are at higher risk of chronic kidney disease. 
  • Hyperlipidemia: The NIH highlighted that older adults with high triglyceride levels and altered lipoprotein composition are at increased risk of chronic kidney disease. Cardiovascular diseases are the leading cause of mortality in CKD and end-stage renal disease patients.
  • High-protein diet: A high-protein diet increases intraglomerular pressure and causes glomerular hyperfiltration, which damages the glomerulus and results in CKD. Hence, NIH recommends a low-protein diet (LPD) of about 0.6-0.8 g/kg/day to manage CKD complications and decrease the load on the kidneys.
  • Hypercalcemia and Hyperphosphatemia: A diet high in calcium and phosphorus directly stimulates vascular calcification (calcium deposition in arterial walls). This condition directly links to excess mortality from chronic kidney disease in older adults and causes complications.
  • Metabolic Acidosis: In metabolic acidosis, the body produces excess acid, and the kidneys cannot remove it efficiently. It affects the kidneys, causes damage to kidney tissues, and worsens the symptoms. In older adults, it is more common due to age-related complications and a decline in kidney function that leads to kidney disease and CKD. 

 

Non Modifiable Factors:

These factors are non-modifiable and contribute to the development of chronic kidney disease in older adults and can not be reversible and manageable through diet, exercise or medicines.

  • Family History: Chronic kidney diseases run in families and people who have CKD in close relatives are at higher risk of getting kidney diseases.
  • Older age: Aging is directly linked with changes in metabolic pathways that impair renal function through glomerular hyperfiltration and oxidative stress. It is a non-modifiable factor and a natural process that increases the risk of CKD in older adults.
  • Race/Ethnicity: It is a non-modifiable factor that contributes to CKD progression in older adults. Compared to white Americans, black Americans are 3-4 times at increased risk of morbidity and mortality linked with chronic kidney disease. 
  • Gender: Males have a higher glomerular filtration rate than females. This is why males of older age are at an increased risk of CKD.
  • Low birth weight: People born with lower birth weight (LBW) lead to a lower number of nephrons which results in a 70% to 80% increased risk of kidney disease in older life.

11. Special Considerations for Older Adults with CKD

Special consideration for older adults depends on considering psychological factors, adjustment in treatment plans, timely medications and modification in lifestyle changes. 

  • Adjustments in treatment plans for the elderly: Treatment plans for older patients include the history of the patient and its functional status. Medicines should be timely taken for the proper functioning of kidneys and to prevent the toxicity of drugs in older adults. Timely medicines and adjustments in treatment plans help to manage other diseases like diabetes and hypertension and also prevent complications.
  • Impact of comorbidities on CKD management: CKD is directly linked with mental and physical conditions. Comorbidities are common in CKD, even in its early stages, like diabetes, hypertension, and heart disease. Comprehensive management of these diseases is necessary for better management of CKD in older adults.
  • Nutritional and lifestyle modifications: Every patient requires a customised treatment plan depending on the condition and status of kidney health. Therefore, nutritional and lifestyle modifications are necessary to maintain a healthy lifestyle for older adults. A diet low in protein, sodium, potassium, and phosphorus is recommended to promote a healthy kidney and its lifelong functions.
  • Importance of patient education and support: Patient education and support are essential to increasing renal patients' knowledge. They are also helpful in addressing the patient’s concerns, questions, and needs regarding kidney disease. Furthermore, they provide ongoing emotional and practical support that helps manage conditions, improves outcomes, and reduces anxiety and decision-making.

For example, Renal patients with diabetes who are older take insulin and medicines, while hypertensive patients take diuretics to manage these complications.

12. Predicting the Development of ESKD

End-stage kidney disease is the last stage of chronic kidney disease in which GFR values decrease up to 15mL per minute. It is a long-term progressive disease that takes years to develop over time. These factors help to predict the development of end-stage kidney disease in renal patients. 

  • Predictive markers and tests for ESKD: Decreased GFR values in blood tests and increased protein levels in the urine tests predict kidney damage. Serum creatinine levels also show the progression of end-stage kidney disease (ESKD).
  • Role of genetics and family history: Genetic predisposition and family history of CKD also increase the risk of progression of ESKD. APOL1 gene variants link to a higher risk of kidney diseases and help predict the possibilities of ESKD in older populations. Similarly, polygenic risk scores also help to estimate the susceptibility of ESKD in higher-risk populations. 
  • Early Warning Signs and Risk Factors: Early signs and risk factors such as diabetes, hypertension, age, gender, obesity, and chronic inflammation increase kidney damage and the chances of developing ESKD.
  • Preventive Measures and Interventions: Preventive measures such as improving lifestyle, healthy diet and management of diseases like diabetes and hypertension reduce kidney damage and slow down the progression of CKD and ESKD.

Several researches are ongoing on ESKD prediction models. These models are based on clinical data, laboratory results, and demographic factors of renal patients. For instance, the prediction model includes the Kidney Failure Risk Equation (KFRE), REIN model, and machine learning algorithms (MLA) that are beneficial for managing kidney complications and preventing ESKD. 

13. Chronic Kidney Disease Stages and KFRE Score

Chronic kidney disease is based on five stages that show how well the kidneys are working. eGFR values and urine albumin-creatinine ratio (uACR) provide a clear picture of kidney health. The diagnosis of CKD at early stages provides a better prognosis of kidney disease.

KFRE is a kidney failure risk equation that provides a predictive score for the progression of chronic kidney disease. This equation is based on four components: age, sex, eGFR, and urine albumin to creatinine ratio (ACR).

 

  • Age: Older patients are at higher risk for kidney failure.
  • Sex: Men and women may have different risks for kidney disease progression. Generally, males are more prone to developing CKD than females.
  • eGFR: Lower eGFR values are linked with a higher risk of progression to ESKD.
  • Albuminuria: The presence of albumin in the urine indicates kidney damage. Higher levels of albuminuria show greater dysfunction of the kidneys. Therefore, people with higher values of albuminuria are at higher risk of disease progression.

Chronic Kidney Disease Stages and KFRE Score

 

The table below shows the stages of CKD and KFRE components.

 

Stages of CKD

eGFR Value (mL/min/1.73 m²)

Kidney Function Description

Symptoms

Stage 1

≥ 90

Normal or high function with kidney damage

Proteinuria or abnormalities in urine test

Stage 2

60-89

Mildly reduced kidney function

Usually asymptomatic

Stage 3a

45-59

Mild to moderate reduction in kidney function

Fatigue, swelling and mild changes in urinary output

Stage 3b

30-44

Moderate to severe reduction in kidney function

Fatigue, nausea, loss of appetite, swelling and urinary changes

Stage 4

15-29

Severely reduced kidney function

Anaemia, bone diseases and metabolic acidosis

Stage 5

< 15

Kidney failure (End-Stage Kidney Disease)

Severe and more noticeable symptoms like itching, muscle cramps, vomiting, loss of appetite, shortness of breath, and changes in skin color.

The Use of KFRE Score in Clinical Practice

  • According to KDIGO, the KFRE scoring system externally verifies a risk equation and assesses the absolute risk of kidney failure in individuals with CKD Stages G3–G5.
  • Along with other factors such as uACR and eGFR values, doctors can also predict the risk of kidney failure over the next 5 years. A 5-year kidney failure risk of 3% – 5% indicates a patient to consult a kidney nephrologist.
  •  A 2-year kidney failure risk of > 10% indicates a need for multidisciplinary care for better management of disease.
  • Besides the values of eGFR-based criteria and other clinical considerations, a 2-year kidney failure risk of > 40% determines when to start modality education and when to start preparing for kidney replacement therapy (including planning vascular access or referring someone for a kidney transplant).

Calculate the KFRE score when measuring the eGFR and ACR of a person with CKD Stage 3a-5. It is recommended to use the KFRE at least once a year, and more often if the disease is in advanced stages. Doctors advise assessing both eGFR and ACR values within six months.

Staging plays an important role in diagnosing kidney health and treating it accordingly. The treatment of renal patients depends on the early detection and stage of CKD.

In the early stages (stages 1 and 2), the treatment includes lifestyle changes, controlling high blood pressure, managing blood sugar levels, and monitoring kidney function.

The mid-stage CKD (stages 3a and 3b) treatment option includes medicine to manage symptoms such as high blood pressure, anaemia, or bone disease.

In the advanced stage of CKD (stages 4 and 5), the treatment option for dialysis or a kidney transplant becomes necessary. Healthcare professionals closely monitor renal patients to observe worsening symptoms, such as electrolyte imbalances. As a result, dietary restrictions involve limiting potassium, phosphorus, and sodium intake.

 

The National Kidney Foundation highlighted a case study showing the complications of ESKD and diagnosis based on KFRE stages. Doctors diagnosed a 70-year-old man with advanced end-stage kidney disease (ESKD) and a GFR of 10 mL/min. He had a history of increased blood pressure. In addition, he reported symptoms of continuous nausea, trouble focusing, and visible swelling. He consulted with his nephrologist, chose to start hemodialysis as a treatment option, and joined the kidney transplant waiting list. After some time, he observed a positive outcome with an improved quality of life on dialysis while waiting for a transplant.

14. Management of CKD

Overview of management strategies for CKD:

Chronic kidney disease is a long-term disorder that is linked to a progressive decline in kidney function that develops over time. The purpose of the management of chronic kidney disease (CKD) is to slow the progression of the disease, reduce the risk of CVD, prevent renal replacement therapy and treat its complications. 

Importance of blood pressure and diabetes control:

Blood pressure and diabetes are the leading cause of CKD. The management of blood glucose and controlling blood pressure is essential to prevent the worsening of CKD symptoms. It is treated with medicines like ACE inhibitors, ARBs and insulin to control blood pressure and diabetes.

Role of Diet and Lifestyle Changes in CKD Management: 

Dietary management and lifestyle changes are essential to managing chronic kidney disease (CKD). A diet low in sodium helps to control blood pressure. Similarly, a low-protein diet reduces pressure on the kidneys and preserves their health. In advanced stages of CKD, doctors recommend a diet restricted in potassium and phosphorus. 

Maintaining a healthy lifestyle and moderate exercise helps to improve physical health in older adults. Maintaining an ideal body weight is also advised for obese patients. 

Medication options and their effectiveness:

Doctors also prescribe medicines other than diuretics and insulin to treat the complications of CKD. For example, they recommend phosphate binders to manage high phosphorus levels in the blood. Similarly, they prescribe diuretics to manage fluid retention and relieve body swelling.

Long-term management and monitoring plans: 

The long-term goals of monitoring CKD patients involve preventing the progression of CKD, promoting physical and psychosocial health and monitoring diseases and their complications. These are some ways to manage chronic kidney disease in the long term.

  • Controlling blood pressure levels in hypertension.
  • Managing blood glucose levels in diabetes.
  • Follow up and monitor kidney health with a healthcare provider
  • Take timely medications according to the prescription
  • Follow a customised meal plan according to the dietitian’s instructions
  • Indulge in physical activity
  • Aim for a healthy body weight

15. Blood Pressure and Kidney Health

Importance of blood pressure control in kidney health:

Hypertension is the second leading cause of kidney failure. It is important to manage blood pressure in chronic kidney disease. High blood pressure constricts and narrows the blood vessels and damages the kidney. These constricted blood vessels reduce blood flow to the kidneys and cause complications. Uncontrolled blood pressure is the leading cause of heart disease, stroke, and kidney disease. The American Kidney Fund reported that 1 in 4 people have renal failure caused by high blood pressure. 

 

Recommended blood pressure targets for CKD patients in older adults:

According to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, the recommended blood pressure for older adults with CKD is 

  • < 140/90 mm Hg if no significant proteinuria is present.
  • < 130/80 mm Hg if proteinuria (urine albumin excretion > 30 mg/24 hours) is present.

Impact of uncontrolled hypertension on kidneys:

Uncontrolled high blood pressure can lead to the narrowing, weakening, or hardening of arteries in and around the kidneys. When damage occurs to these blood vessels, the kidneys struggle to receive the oxygen and nutrients necessary for proper function. In addition, high blood pressure can also cause scarring of kidney tissue. It also impairs the kidneys' ability to filter blood and regulate fluid and electrolytes. Moreover, it results in high blood pressure, which is more difficult to control. Without treatment, high blood pressure can lead to disability, poor quality of life, or heart attack or stroke.

Medication and lifestyle interventions for blood pressure control: 

Lifestyle changes are the first step in managing blood pressure. Doctors also treat it with medicines such as diuretics, angiotensin 2 receptor blockers (ARBs), ACE inhibitors, and calcium channel blockers (CCBs). The follow-up of blood pressure is necessary for the normal functioning of the kidneys. These are ten ways to control high blood pressure without using medicines. It includes:

  • Maintain a healthy body weight and lose extra weight. Also, monitor the waistline.
  • Walk and exercise regularly
  • Eat a healthy diet rich in fruits and vegetables 
  • Reduce salt and sodium from the diet 
  • Limit alcohol intake
  • Quit smoking 
  • Take sufficient sleep at night and strictly follow a sleep schedule
  • Manage stressful conditions and stay away from stress triggers
  • Track blood pressure at home and get regular checkups
  • Control blood sugar levels and cholesterol to normal ranges.

The Kidney Early Evaluation Program (KEEP) study highlighted that increases in systolic blood pressure (SBP) up to 140mmHg and diastolic blood pressure (DBP) up to 90mmHg increases the risk of end-stage renal disease as compared to normal values. 

The NIH also shared the result of recent research highlighting that the renal patient with high SBP 140–169 mmHg was a dominant outcome predictor of CKD stages 3 and 4.

16. Obesity and Kidney Health

Obesity directly affects kidney health, especially in older adults. Increased body weight is a potent risk factor for developing kidney diseases. It is directly linked with glomerular hyperfiltration and increased albuminuria. It increases the kidneys' workflow and gradually damages them over time. In addition, obesity also increases the risk of kidney stone formation, hypertension, diabetes, and dyslipidemia.

Relationship between weight loss and kidney health: 

Body Mass Index (BMI) is useful for estimating body fat based on a person's height and weight. BMI has four categories:

  • Underweight: Less than 18.5 kg/m2
  • Normal weight: 18.5-24.9 kg/m2
  • Overweight: 25-29.9 kg/m2
  • Obese category type 1: 30-34.9 kg/m2
  • Obese category type 2: 35-39.9 kg/m2

The values above normal ranges indicate overweight and obesity, which increases the risk of kidney diseases and other health complications. The National Kidney Foundation (NKF) shared that weight loss and maintaining weight in normal ranges help preserve kidney functions. It also reduces levels of protein in the urine (albuminuria), controls blood pressure, and reduces the risk of CKD progression.

For older adults, losing weight gradually through lifestyle changes can reduce stress on the kidneys, lower the chances of developing diabetes or high blood pressure, and enhance overall kidney health.

Dietary recommendations for obese CKD patients:

Obese patients are recommended with the following dietary instructions:

  • Consume a low protein diet with high biological values like eggs, milk, meat, poultry, and fish.
  • Choose complex carbohydrates including whole grain, brown rice and barley and avoid eating refined food items such as white sugar and processed food.
  • Consume vegetable fats that are low in saturated fat.
  • Consume sodium-free seasonings, herbs and spices instead of salt.
  • Limit foods and drinks that are high in phosphorus and potassium.

The National Kidney Foundation (NKF) also recommends a DASH diet that is high in fruits, vegetables, whole grains, lean protein, and low-fat dairy products. This diet significantly reduces blood pressure and decreases the risk of kidney diseases, especially in older adults. 

Exercise guidelines for managing obesity:

Exercise and physical activity play a crucial role in managing obesity in older adults, but individuals should consider kidney health while engaging in these activities. Experts suggest low-impact exercise - walking, swimming, cycling etc.

Older adults must consult a healthcare provider before exercising. These activities enhance cardiovascular health and help with weight loss while lowering the stress on the kidneys. Additionally, resistance training can help preserve muscle mass, which is vital for older adults to sustain mobility and overall health.

The American Journal of Kidney Diseases and Journal of Clinical Endocrinology and Metabolism shared the findings of its research. The study also found that obesity alone causes not only the development of kidney disease but also delays in the prognosis for patients diagnosed with kidney disease. Researches also show that older adults with obesity and CKD are more likely to suffer kidney disease progression than doctors treat this condition with dialysis or kidney transplants compared to those with a healthier weight.

17. Hypertension and Cardiovascular Disease

Hypertension, cardiovascular disease, and kidney function are intimately related. Hypertension is the primary cause of cardiovascular disease (CVD) and chronic kidney disease (CKD). It constricts and narrows the blood vessels, destroys the arteries and weakens the body.

If the blood flows through the arteries under high pressure, it leads to endothelial damage of blood vessels. It puts pressure on the heart and increases the risk of developing cardiovascular diseases such as heart attack, stroke, and heart failure.

Similarly, hypertension also puts stress on the kidneys and damages their nephrons, resulting in the development of progressive chronic kidney disease (CKD).

Shared risk factors and management strategies: 

The risk factors for hypertension, CVD and kidney health are common. It includes

  • Age (Higher risk in older adults)
  • Obesity
  • Diabetes
  • Smoking
  • Sedentary lifestyle and poor diet intake

Importance of holistic management of all three conditions:

It is essential to manage these complications together. Hypertension, cardiovascular diseases, and kidney diseases are interrelated, and treating one can improve treating the other.

The targeted strategy is to control BP, cardioprotection, and slowing progression of renal scarring. Renal patient is capable of self-management through lifestyle changes, adherence to a heart--healthy diet (e.g., the DASH diet), physical activity, cessation of smoking and maintaining a healthy body mass index.

Blood pressure monitoring can help sustain normal kidney function and is particularly important in elders.

 

For example, using blood pressure medication and lifestyle adaptations not only benefits the heart but also delays the kidney deterioration process. Treating one condition without considering the other condition can have adverse health consequences. Thus, a comprehensive treatment is essential for elderly individuals with these multiple comorbidities.sing blood pressure medication and lifestyle adaptations not only to benefit the heart but also to delay the kidney deterioration process. 

Medication options for combined conditions: 

Several medicines are effective in controlling blood pressure, including antihypertensive drugs, diuretics, ACE inhibitors, and ARBS. A combination of drugs is prescribed to treat complications. The NIH reported that treatments such as Calcium Channel Blockers (CCBs) effectively serve as second-line antihypertensive agents. The combination of medicines to treat these complications includes

  • ACE inhibitors and ARBs (angiotensin receptor blockers): These drugs also widely recognize their capacity to decrease blood pressure and protect the heart and kidneys by slowing down disease progression.
  • Beta Blockers: They regulate blood pressure and heart rate and prevent cardiovascular disease [i.e., myocardial infarction and stroke].
  • Diuretics: Diuretics, also known as water pills, reduce fluid retention. They also directly reduce blood pressure and protect the heart and kidneys.
  • Calcium Channel Blockers: They show promising efficacy in reducing of blood pressure and preventing cardiovascular events.

In age-related alterations in metabolism and renal function, healthcare personnel carefully adjust dosages and potential adverse drug effects in the elderly.

The KDIGO presented a case report study of chronic kidney disease, hypertension and heart failure patients. A 65-year-old man suffering from stage 3 CKD, uncontrolled hypertension and heart failure with compensated ejection fraction (HFpEF) was diagnosed.

His treatment plan focused on optimising antihypertensive medications, such as ACE inhibitors, to manage blood pressure and protect kidney function. Furthermore, the doctor advised diuretic therapy and a sodium-restricted diet to control his volume status. 

The medical team also monitored the patient's cardiovascular health using echocardiography and the serum biomarker BNP to evaluate his heart failure. Coordination with his nephrologist, cardiologist, and family physician provides optimal care in a balanced way for his conditions, which in turn leads to better overall health results.

18. Diagnosis and Treatment

In older adults, the diagnosis of chronic kidney disease requires several tests to confirm the damage to the kidneys caused by complex changes related to ageing. It includes:

  • Blood Tests: Blood tests assess serum creatinine concentration and estimated glomerular filtration rate (eGFR). Because muscle mass is reduced, eGFR may be less accurate in elderly patients compared to younger patients. Thus, cystatin C concentrations are most commonly applied to kidney surveillance in geriatric populations.
  • Urine Tests: The urine test is useful for the assessment of urinary protein.
  • Imaging Techniques: The imaging test involves ultrasound and CT scans. Ultrasound generates a structural image using sound waves, whereas a CT scan generates an image from the detailed X-rays of a diseased kidney.

Kidney disease treatment approaches vary depending on CKD stage in elderly patients. In early stage CKD 1-3, treatment concerns provide for the management of associated conditions in order to treat the underlying cause. For instance, ACE inhibitors or ARBs are typically prescribed to reduce blood pressure and retard kidney deterioration. In stages 1-3, the guidelines of CKD diet are to restrict sodium and protein content to lower the kidney load.

Also, in late CKD (stages 4 and 5), the only option is dialysis to overcome complications such as anaemia, metabolic bone disease, and oedema/fluid retention. The choice of the dialysis modality is made based on the patient's clinical condition and quality of life.

The early detection of chronic kidney disease (CKD) is considered to be crucial for the prevention of disease progression in elderly patients. Regular screening is essential for people who are at higher risk, such as individuals with diabetes or hypertension. The treatment at early stages through lifestyle modifications, medications, and regular monitoring of kidney health can help slow down the disease's progression and prevent the complications of cardiovascular diseases. This strategy can enhance both life expectancy and overall quality of life.

Patient education is critically important in the management of CKD, particularly in older adults with comorbidities. To improve treatment results, patients need to be knowledgeable of the disease, adhere to medications and dietary limitations, and attend regular follow-ups.

According to NIDDK, early intervention can preserve kidney function and enhance cardiovascular health in older adults with chronic kidney disease (CKD). For example, older adults who use ACE inhibitors to manage blood pressure and modify lifestyle changes usually experience a slower progression of CKD in older adults.

Therefore, when dialysis treatment becomes necessary, customised care plans can adjust dialysis frequency and manage anaemia more efficiently with better health outcomes and a higher quality of life.

19. Kidney Biopsy: Should You Undergo One?

A biopsy of the kidney is a diagnostic procedure in which a small amount of renal tissue is extracted to analyze renal tissues. It is advised when more specific data is needed for the diagnosis of kidney disease estimating the stage of kidney disease, particularly when other tests failed to provide the required data, such as blood tests, urine or imaging studies.

Clinicians generally diagnose alternative complications in elderly patients, such as proteinuria, hematuria, or acute kidney injury, when the underlying reason cannot be identified. They can also interpret the aetiology of chronic kidney disease (CKD) or recommend treatment decisions for glomerulonephritis or vasculitis.

Risks and complications related to kidney biopsies are higher among the elderly due to ageing, existing comorbidities, and the risk of bleeding. Infection, severe pain, bleeding and kidney injury are possible complications of kidney biopsy.

However, kidney biopsy has significant advantages. It delivers a reliable assessment of the kidney's state, which can inform personalised treatment plans, enhance prognosis, and sometimes help avoid unnecessary interventions. In older patients, a biopsy is necessary to determine whether to continue intensifying therapy or switch to a more conservative approach.

Kidney biopsy is a procedure commonly performed under ultrasound or CT guidance by doctors. They position the patient face down and administer local anaesthesia. Next, they carefully insert a needle the skin and guide it into the kidney to extract tissue samples. The kidney biopsy procedure usually lasts 30 to 60 minutes, and medical staff observe patients for several hours afterwards to check for any complications, such as blood in the urine. Patients can be discharged at home on the same day, but doctors do suggest avoiding strenuous activity for about one week.



 Kidney Biopsy

The NIH reported the effects of kidney biopsies. Older adults with kidney biopsies often report pain during their procedure. The most frequent complication is minor pain or bruising at the biopsy site.

Some patients report symptom relief when biopsy findings result in a definitive diagnosis, which can be refined with more precise treatments.

In testimonies, the patient can note the relevance of the possible risks in relation to their doctors and is well prepared before the operation.

Positive experiences are commonly associated with clear communication by health care professionals regarding what to expect before and after the biopsy.

Recent research on a 70-year-old woman revealed rapid loss of kidney function and proteinuria. A kidney biopsy revealed minimal change in disease, an unexpected finding that initiated immunosuppressive therapy, leading to a noticeable improvement in her condition.

In another research, a biopsy for an 80-year-old man revealed unexplained hematuria, indicating advanced interstitial nephritis. Accordingly, the patient was treated with targeted steroid therapy, which alleviated his renal function and improved his quality of life.

20. Standard Therapy for Diagnosed Patients

Standard treatments of elderly patients with CKD are dialysis therapy and kidney transplantation therapy. Nevertheless, these choices are not always the right or the best choice for given scenarios because of a patients clinical status, concomitant medical disorders and personal choices.

Dialysis: From the clinical point of view, dialysis is routinely suggested for advanced-age patients experiencing low renal function (GFR inferior to 15 mL/min) and having this therapy as a need. There are two kinds of dialysis, namely, hemodialysis and peritoneal dialysis.

  • Hemodialysis: Haemodialysis necessitates patient participation and several sessions per week, and it may not be an acceptable treatment option in elderly patients with concomitant cardiovascular disease.
  • Peritoneal Dialysis: Compared to haemodialysis, peritoneal dialysis is less stressful on the heart and can be carried out at home. This treatment is advantageous for patients who want to have an expendable schedule and also for patients who can manage home dialysis.

 

Dialysis extends survival and improves the quality of life for a significant number of older patients. At the same time, this approach paradoxically leads to reduced effectiveness and increased risk since it carries the risk of infection, malnutrition, fluid overload, and complications such as pneumothorax. Elderly patients, in addition, suffer from low survival rates because of comorbidities, which subsequently increases the risk of death.

 

Kidney Transplant: Kidney Transplant: Kidney transplantation is regarded as a chronic management therapy for CKD patients. Nevertheless, physicians reported less frequently the administration of the procedure in older patients because of the presence of complications related to surgery and the use of immunosuppressive drugs. Transplantation entails delicate selection of candidates, and physicians can reject a large number of elderly patients for factors such as age, or conditions like cardiovascular disease and diabetes.

Transplants improve the quality of life and survival rate for patients over the age of 65 who can undergo the process, compared to dialysis.

But the success depends on the speed of postoperative condition as well as the ability to use immunosuppressive drugs for the life of the patient. Infections and cardiovascular complications are the major risk factors in elderly patients.

Several elderly CKD patients receive personalised treatment plans based on assessments of their health condition, living situation, and preferences. Palliative care treatment can be a possibility when the risk of employing dialysis or transplantation is greater than the salvage benefit. In this therapeutic modality, symptoms are controlled, the quality of life of the patient is enhanced, and palliative treatments are administered.

The treatment protocol for standard therapy in elderly individuals consists of:

Dialysis Protocol: Detailed care plan including hydration monitoring, electrolyte balance and nutritional intervention are just a few examples. Such changes are based on tolerances and complications.

Transplant Protocol: Corticosteroid doses are administered in reduced amounts while other immunosuppressives are altered to minimize side effects. Close follow-up is performed for signs of rejection or infections, especially for older patients.

The research by NIH concluded that older patients who receive hemodialysis are associated with suffering from more chronic conditions as compared to adults. They suffer from diminished physical performance, lower quality of life, reduced life expectancy and a higher burden of geriatric manifestations, including vulnerability to functional and cognitive decline.

The NIH also showed higher patient satisfaction among adults, which is linked to conservative management techniques. Conservative management (treatment without dialysis and renal transplant) of CKD is in keeping with patients' desire for comfort and enhanced quality of life.

21. Dialysis and Kidney Transplant in the Elderly

When beginning any treatment several factors need to be taken into account for older age.

 

Consideration for Dialysis Patients: 

  • Physical Health: Elderly patients are typically complex patients with comorbidities unlike CKD, including cardiovascular disease and diabetes, and this makes the dialysis process more complicated. Furthermore, various complications such as frailty, reduced mobility and cognitive impairment also decrease the patient's ability to sustain a stable dialysis schedule.
  • Type of Dialysis: Hemodialysis is generally also associated with at least 3 visits per day to the dialysis centre, which can be tiring for frail older patients. However, peritoneal dialysis offers more freedom of choice and is a less invasive method. However, this involves a manual procedure requiring either the patient or a caregiver to perform the procedure, which is only sometimes possible.
  • Quality of Life: Dialysis normally increases the survival rate for many patients, but in elderly patients, regular treatment and side effects such as fatigue, increased risk of infection, and lower blood pressure decrease the quality of life. Doctors must make decisions according to the physical and emotional burden of treatment and its advantages.

The longevity of a kidney dialysis patient is determined by medical status and treatment protocols. Compared to adults, elderly patients have shorter life expectancies. Recent work in the U.S. Renal Data System indicated that the life expectancy of elderly patients ranged from 5-10 years, but many patients may still survive for 20-30 years.

 

Consideration for Kidney Transplant Patients: 

Eligibility: Kidney transplant is a better option than dialysis in candidates. Nevertheless, surgical pain is too much to ask for many elderly patients because of age-related causes, including frailty, comorbid conditions and obligation for lifelong immunosuppressive drugs, both elevating the chance of infections and cancers.

Lifelong Immunosuppressive Medicines: Following transplant, immunosuppressive drugs are prescribed to prevent organ rejection. Nevertheless, because immunity weakens with age, these drugs raise the risk of infections in elderly patients.

Surgical Risks: Older patients face a higher risk of complications during and after surgery, such as delayed wound healing, associated cardiovascular issues, and infections.

Kidney transplant success rates are better even for elderly patients if those candidates are selected carefully. Yet, the long-term outcome is determined by the patient's compliance with post-transplant management, including lifelong medication and regular visits to the follow-up clinic.

 

Dialysis can extend life for elderly patients, but it is linked with decreased quality of life, especially if complications arise or hospital visits become frequent. There are some older people who favour conservative management when they experience the dialysis process being difficult.

 

In the case of eligible elderly patients, transplantation generally results in improved long-term outcomes in terms of survival and quality of life. They typically have fewer dietary restrictions, fluid limitations, and dependence compared to those on hemodialysis.

 

Both dialysis and kidney transplants can be effective treatment options for older patients with chronic kidney disease (CKD), but their suitability depends on the individual's overall health and personal choices.

 

Dialysis can prolong life but can also reduce life quality for some patients, especially those with additional health problems. Kidney transplants, however, are more technically challenging and riskier for older adults but generally have longer-term survival rates of benefit for candidates. The choice of treatment requires careful decision-making, considering associated risk, balance of effectiveness, and the patient's quality of life goals.

22. Timing of Dialysis in the Elderly

The best time to begin dialysis in old age depends upon various indicators, including.

 

Kidney functioning and stage of CKD: Dialysis should be consider in the case of low GFR values, i.e., below 15 mL/min/1.73 m2. Sometimes, doctors also suggest dialysis with GFR values of 9–12 mL/min/1.73 m2, depending on the condition.

Severe symptoms: Dialysis is best performed in the case of the disease presentation of severe symptoms like breathlessness, muscle tightening, fatigue, nausea and vomiting.

Other health conditions: In some cases, early treatment with dialysis may be provided for patients with other medical conditions.

Vascular access: Vascular access should be chosen according to the needs of elderly patients. Central venous catheters decrease the incidence of nosocomial bloodstream infections, but brachial fistulas have damaging cardiovascular effects.

The nutritional status, daily activities, and quality of life in elderly patient all play a role in achieving optimal dialysis timing.

 

Benefits of early versus delayed dialysis: Early dialysis helps to prevent many complications linked with renal failure, such as CVD issues, severe electrolyte imbalances, and malnutrition. However, early diagnosis leads to an unnecessary treatment burden that decreases quality of life and associated side effects such as fatigue and infections. The NIH reported that early dialysis does not improve clinical outcomes and survival rates in elderly patients, but it may result in overtreatment in some cases.

 

The research from NIH highlighted that delaying dialysis in elderly patients with stable kidney function and manageable symptoms does not affect survival rates as compared to early treatment methods. Early dialysis, however, has been shown to reduce the quality of life as a result of the treatment burdens when life expectancy is not reduced.

 

The NIH highlighted the IDEAL (Initiating Dialysis Early and Late) study, which indicates that starting early dialysis does not noticeably enhance survival rates for patients with end-stage kidney disease (ESKD), even among older adults. 

23. Kidney Transplant in the Elderly

Kidney transplant selection and treatment of elderly are dependent on a number of factors, but not only age. These variables are the patient's general health, previous comorbidities (e.g., diabetes or cardiovascular disease), and functional status.

Criteria for transplant eligibility:

Patients are subjected to multiple medical examinations prior to the transplant procedure, in order to be eligible for transplantation surgery. Kidney transplantation is more suitable for patients with minimal comorbid conditions, good physical and mental ability.

The transplantation of a kidney also depends on the supply of a donor. Although both options are substantial, when compared to deceased donors, living donors have shown better results and positive survival rates. The surgical risk in kidney transplants increases with age. Geriatric patients suffer from enhanced risk of infection, weakened wound healing, and underlying cardiovascular disease in the post-transplant surgical environment.

Impact on quality of life and survival rates.

According to the NIH, kidney transplantation (KT) outcomes in older patients, long-term patient survival and graft survival are worse compared with the younger patient population. The selection of older candidates (e.g., geriatric evaluation) in kidney transplantation is of primary importance to obtain better results.

The prognosis rate in long-term renal transplantation of old-age patients is different. The older patients experience lower graft survival rate due to higher prevalence of other diseases such as CVD and diabetes. These diseases complicate post-transplant revovery conditions because age factors also affect the post transplant recovery stage. Survival outcomes for older adults are less than optimal >5-year survival at age compared to survival at ages due to age-related and other reasons. However, people with age 65 to 70 show a better survival rate of transplant as compared to dialysis.

Many elderly transplant patients shared positive experiences and improved quality of life after the transplant surgery. Testimonials from patients show that they regained independence, experienced less fatigue, and enjoyed more freedom from strict routines and restricted diets compared to dialysis.

24. Regular Monitoring

Regular monitoring is important for elderly patients with CKD because it helps to track the disease progression, control blood pressure, identify associated complications, and choose the most suitable treatment. It is also useful to detect renal function decline and electrolyte dysfunction.

Detecting early kidney disease can influence appropriate efforts to manage disease progression in a timely manner, improve quality of life, and reduce symptoms through pharmacological intervention.

Recommended frequency and methods of monitoring.

The National Institute of Health (NIH) shared the best follow-up for CKD in the elderly according to the stages and degree of proteinuria. During stable states, surveillance of CKD patients should be performed at a minimum every 3-6 months, and regular examinations should be performed in advanced disease.

  • In stage 3a: follow-up should be every 3–6 months 
  • Stage 3b: follow-up is required in 3 months 
  • In stage 4: 1–3 months 
  • Stage 5: strictly follow-up in every month

Close monitoring is necessary for elderly transplant patients initially (once or twice a week), but healthcare providers can decrease the frequency after kidney function stabilizes over time, if appropriate. Doctors assess renal function in the elderly through blood tests, urinalysis, and imaging tests (such as computed tomography). They also use ambulatory blood pressure monitoring and perform haemodialysis.

Role of regular check-ups in disease management:

Continuous monitoring is critical for dialysis patients with old patients, as it helps to obtain the optimal clinical outcome and enhance the quality of life. This process involves monitoring blood chemistry and managing vascular access. When necessary, changes in the dialysis prescription are introduced. 

Impact of monitoring on patient outcomes: 

Regular monitoring of the elderly with CKD could reduce the mortality risk. By effectively managing complications and timely treatment changes, patients can prevent serious health issues like heart attacks, strokes, or dangerous electrolyte imbalances.

The American Journal of Kidney Diseases published a study showing that dialysis patients who undergo frequent vascular access monitoring have a 25% lower re-rate of catheter-related infections, fewer hospitalisations, and better health outcomes.