Management of Elderly Patients with Chronic Kidney Disease

Abstract

Chronic kidney disease (CKD) is highly prevalent among elderly patients, and as the global population ages, the number of elderly patients with CKD is increasing. Elderly patients require additional considerations beyond those required for their younger counterparts, such as comorbidities, frailty, and geriatric syndromes. In this review, we primarily focus on these additional considerations specific to elderly patients and discuss the assessment of CKD and its management strategies, including blood pressure and glycemic control; dyslipidemia, anemia, and electrolyte and metabolic acidosis management; and medication dosage, among others, as well as polypharmacy and nonpharmacological management. Furthermore, the concept of conservative kidney management and the practical recommendations of the Korean Society of Geriatric Nephrology for elderly patients with end-stage kidney disease requiring dialysis therapy are discussed. In particular, the aging rate in Korea is exceptionally high; therefore, it is crucial to pay more attention to the increase in elderly patients with CKD. A more palliative approach, rather than intensive treatment strategies, may be necessary for these patients. In a world with an abundance of information, shared decision-making with patients is of great importance, and it is essential to keep in mind that this holds true for elderly patients as well.

Keywords: Disease management; chronic kidney disease; frail elderly.

Fig. 1. Risk stratification and management algorithm based on the REIN score for elderly patients with ESKD. Patients with a REIN score of ≥17 are classified into the high-risk group, those with a score of 12–16 are classified into the intermediate-risk group, and those with a score of ≤12 are classified into the low-risk group. Given that the early mortality rate in the high-risk group exceeds 40%, immediate shared decision-making is crucial. Conservative kidney management should also be considered an option during the decision-making process. Modified from Couchoud et al. Kidney Int 2015;88:1178-1186. CKD, chronic kidney disease; ESKD, end-stage kidney disease; REIN, Renal Epidemiology and Information Network.