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Review
. 2022 Oct 28;12(11):1724.
doi: 10.3390/life12111724.

Rethinking Chronic Kidney Disease in the Aging Population

Gaetano Alfano  1 , Rossella Perrone  2 , Francesco Fontana  1 , Giulia Ligabue  3 , Silvia Giovanella  3   4 , Annachiara Ferrari  5 , Mariacristina Gregorini  5 , Gianni Cappelli  3 , Riccardo Magistroni  1   3 , Gabriele Donati  1   3
Affiliations
Review

Rethinking Chronic Kidney Disease in the Aging Population

Gaetano Alfano et al. Life (Basel). .

Abstract

The process of aging population will inevitably increase age-related comorbidities including chronic kidney disease (CKD). In light of this demographic transition, the lack of an age-adjusted CKD classification may enormously increase the number of new diagnoses of CKD in old subjects with an indolent decline in kidney function. Overdiagnosis of CKD will inevitably lead to important clinical consequences and pronounced negative effects on the health-related quality of life of these patients. Based on these data, an appropriate workup for the diagnosis of CKD is critical in reducing the burden of CKD worldwide. Optimal management of CKD should be based on prevention and reduction of risk factors associated with kidney injury. Once the diagnosis of CKD has been made, an appropriate staging of kidney disease and timely prescriptions of promising nephroprotective drugs (e.g., RAAS, SGLT-2 inhibitors, finerenone) appear crucial to slow down the progression toward end-stage kidney disease (ESKD). The management of elderly, comorbid and frail patients also opens new questions on the appropriate renal replacement therapy for this subset of the population. The non-dialytic management of CKD in old subjects with short life expectancy features as a valid option in patient-centered care programs. Considering the multiple implications of CKD for global public health, this review examines the prevalence, diagnosis and principles of treatment of kidney disease in the aging population.

Keywords: RAAS; SGLT-2; aging; chronic kidney disease; creatinine; dialysis; finerenone; glomerular filtration rate; palliative care; proteinuria; renal replacement therapy; senescence.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Age- and gender-specific GFR reference ranges. Data include pre-donation mean GFR from 2974 prospective living kidney donors from 18 UK renal centers performed between 2003 and 2015. Solid lines represent mean GFR and interrupted lines are two standard deviations above and below the mean.
Figure 2
Figure 2
Age-related threshold for diagnosis of CKD.
Figure 3
Figure 3
Risk factors for CKD progression.
See this image and copyright information in PMC

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