Chronic Kidney Disease in Elderly: Do Kidneys Behave Differently as we age?

With aging population, the incidence of chronic kidney disease (CKD) and end-stage kidney disease (ESKD) is steadily increasing. It increases not only the cost to health care but also tremendous physical and mental strain on this vulnerable population. Among all the various equations to assess kidney function, serum cystatin C is probably the best one but not used routinely. Elderly age group has age related decline in renal function and have significant co-morobid conditions which contrubute to chronic kindey disease. The silver lining is that the rate of progression to ESRD is slower in elderly population with CKD. The survival of elderly population >70 years of age on dialysis is poor, with poor quality of life as well. Data on elderly patients and post-transplant outcome are sparse but encouraging in carefully selected patients. Kidney replacement therapy modality should be decided based on patient’s overall co-morbid disease burden, functional status, goals of care, and life expectancy. Palliative care should always be an option and requires an open dialogue between patient and physician.