CKD in older people

If you was diagnosed with Chronic Kidney Disease(CKD) you should treat early.Because If you Don't pay more attention to this disease.It will develop into kidney failure.If a older people had kidney failure will be difficult to get cured.Because they will not suitable for surgery.

The majority of patients diagnosed with Chronic Kidney Disease (CKD) are elderly and CKD is linked with poor cardiovascular, cognitive, and disability outcomes in these people. Only a minority of these patients will progress to end stage renal disease (ESRD) while the majority will die due to cardiovascular disease. Thus, only a small number of these patients with CKD will benefit from specialist nephrologist assessment. The priority for the remainder should be cardiovascular disease prevention. We have reviewed specific issues relevant to older people to determine high-risk groups with CKD that are likely to benefit from a more intensive risk reduction intervention and to allow identification of clinically relevant renal disease.

Introduction

The prevalence of Chronic Kidney Disease (CKD) has been rising and is causing a global challenge as a non-communicable epidemic. In the UK, the prevalence is about 10% of the po­pulation, and in people aged over 65 years, this figure reaches 40%. Risk factors predis­posing the elderly to CKD remain unknown. However, most analyses show that the majo­rity of patients affected either with microalbu­minuria (MA) or with reduced glomerular fil­tration rate (GFR) are the elderly (> 65 years). Cardiovascular disease (CVD) has a significant impact on CKD in the elderly and affects CKD progression in this age-group. It is well known that renal function declines with age. It is still not clear whether CKD in older people is merely due to age-related changes in kidney function or a genuine kidney disease that will progress to end-stage renal disease (ESRD). Nevertheless, we already know that a minority of elderly patients with CKD will progress to ESRD and that the majority will have mor­bidity and mortality related to CVD, rather than ESRD. However, labeling older, frail pa­tients with a significant disease can be wo­rrying for them, especially if that will include asking them to travel long distances for spe­cialist secondary and tertiary services. With these above concerns, there has been evolving national and international guidelines to guide primary care physicians and non-renal specialists to refer patients according to the CKD stage. Most of these guidelines have overlooked the age stratification and they have been cri­ticized for building guidance based upon esti­mated glomerular filtration rate eGFR alone (calculated by The Modification of Diet in Renal Disease [MDRD] equation, which has not been validated in patients above the age of 70 years). Currently, there are no other more accurate methods to estimate GFR in older people with CKD. Another marker which has been found to be superior to serum creatinine in measuring GFR is cystatin C, which may have future implications for older people.
The majority of elderly patients with CKD are in stage three that could well be managed in the community by primary care physicians. The most important issue is to address the high CVD risk in this population which is confoun­ded by the co-existence of CKD. In addition, CVD is known to accelerate CKD progression in elderly subjects. The importance of early detection and prevention has been the focus of many national and international guidelines and standards frameworks. Finding a simple and feasible screening tool for early CKD detec­tion has been an attractive goal.
Microalbuminuria and low GFR are very co­mmon in individuals > 65 years, which contri­butes to the large prevalence of CKD reported in this age-group. There is evidence that MA is a strong predictor of CVD risk in the general population. It is not clear, however, whether MA in early CKD is a marker of kidney da­mage or widespread CVD including atheroscle­rosis and peripheral vascular disease, which are not uncommon in the elderly.

Search Strategy

We performed a search of Medline and Embase from January 1969 to September 2009 using keywords relating to CKD in older people and vascular and renal outcomes. Only English language articles were selected. Articles were reviewed for relevance by abstract. A manual review of citations in retrieved articles was performed in addition to the electronic lite­rature search. The final list of cited references was chosen on the basis of scientific quality and relevance to the topic of review.

Definition

Chronic Kidney Disease is defined as either a low GFR rate of less than 60 mL/min/1.73 m 2 , or normal GFR plus evidence of kidney da­mage (most commonly albuminuria, hematuria or abnormal renal ultrasound for three or more consecutive months) regardless of age.The severity of CKD is classified according to the level of GFR, regardless of the etiology, into five stages:
Stage one: kidney damage with a normal or increased GFR (> 90 mL/min/1.73 m 2 );
Stage two: kidney damage with a mild decrease in GFR (60-89 mL/min/1.73 m 2 );
Stage three: a moderate decrease in GFR (30-59 mL/min/1.73 m 2 );
Stage four: a severe decrease in GFR (15­ 29 mL/min/1.73 m 2 ) and
Stage five: kidney failure (< 15 mL/min/1.73 m 2 ).

Older people are particularly susceptible to kidney damage from age-related decline in glomerular filtration as well as kidney damage from chronic disease states such as diabetes mellitus, hypertension, glomerular, and tubulo­interstitial disorders. The classification of CKD is applicable to all age-groups despite the fact that GFR gradually declines with age. Whether this decline is part of a normal ageing process is uncertain. Age-related decline in GFR is associated with impaired concentrating ability, global glomerular and vascular sclerosis and tubular atrophy with thinning of renal cortex and reduction in kidney size. These changes are considered pathological if observed in younger individuals.

Treatments

In my opinions Traditional Chinsese Medicine will ease the development of the kidney disease.Do you heard Micro-Chinese Medicine Osmotherapy,This therapy could make the herbs enter kidneys directly.And will have amazing effects in the treatment progress.

Have any questions?Send me an email kidney-treatment@hotmail.com .