Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-7479d7b7d-8zxtt Total loading time: 0 Render date: 2024-07-10T22:29:36.406Z Has data issue: false hasContentIssue false

Chapter 25 - Renal disorders in the elderly

from Section III - Care of the elderly by organ system

Published online by Cambridge University Press:  05 June 2016

By
William D. Sirover ,
Brooke Salzman  and
Christopher B. McFadden
Edited by
Jan Busby-Whitehead ,
Christine Arenson ,
Samuel C. Durso ,
Daniel Swagerty ,
Laura Mosqueda ,
Maria Fiatarone Singh  and
William Reichel
Jan Busby-Whitehead
Affiliation:
University of North Carolina
Christine Arenson
Affiliation:
Thomas Jefferson University, Philadelphia
Samuel C. Durso
Affiliation:
The Johns Hopkins University School of Medicine
Daniel Swagerty
Affiliation:
University of Kansas
Laura Mosqueda
Affiliation:
University of Southern California
Maria Fiatarone Singh
Affiliation:
University of Sydney
William Reichel
Affiliation:
Georgetown University, Washington DC
Get access

Summary

Kidney function changes with aging. Elderly patients with kidney disease are at increased risk for a number of disorders, including alterations in electrolytes, changes in sodium absorption, and chronic changes in kidney function. Traditional estimations of glomerular filtration rate from serum creatinine, through the use of estimating equations, may not be appropriate for the geriatric population, particularly when results suggest only mild impairment in kidney function without proteinuria or hematuria. Still, as the population ages, kidney disease prevalence grows as well. Also, acute kidney injury (AKI) commonly occurs in this patient population. Anatomic and physiologic changes appear to be contributory. Complexities associated with kidney disease in the elderly include the risks as well as benefits of polypharmacy, the timing and indications of referral for specialist care, and the appropriateness of dialysis initiation, presenting challenges for the clinician.
Type
Chapter
Information
Reichel's Care of the Elderly
Clinical Aspects of Aging
 , pp. 357 - 365
Publisher: Cambridge University Press
Print publication year: 2016

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Lindeman, RD, Tobin, JD, Shock, NW. Association between blood pressure and the rate of decline in renal function with age. Kidney Int 1984;26:861–8.Google Scholar
Coresh, J, Astor, BC, Greene, T, et al. Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey. Am J Kidney Dis 2003;41:1–12.CrossRefGoogle ScholarPubMed
Kaplan, C, Pasternack, B, Shah, H, Gallo, G. Age-related incidence of sclerotic glomeruli in human kidneys. Am J Pathol 1975;80:227–34.Google Scholar
Weidmann, P, De Myttenaere-Bursztein, S, Maxwell, MH, de Lima, J. Effect on aging on plasma renin and aldosterone in normal man. Kidney Int 1975;8:325–33.CrossRefGoogle ScholarPubMed
Preisser, L, Teillet, L, Aliotti, S, et al. Downregulation of aquaporin-2 and -3 in aging kidney is independent of V(2) vasopressin receptor. Am J Physiol Renal Physiol 2000;279:F144–52.Google Scholar
Fliser, D, Zeier, M, Nowack, R, Ritz, E. Renal functional reserve in healthy elderly subjects. J Am Soc Nephrol 1993;3:1371–7.Google Scholar
Corman, B, Barrault, MB, Klingler, C, et al. Renin gene expression in the aging kidney: effect of sodium restriction. Mech Ageing Dev 1995;84:1–13.Google Scholar
Levey, AS, Bosch, JP, Lewis, JB, et al. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of diet in renal disease study group. Ann Intern Med. 1999;130:461–70.Google Scholar
Coresh, J, Selvin, E, Stevens, LA, et al. Prevalence of chronic kidney disease in the United States. JAMA 2007;298:2038–47.CrossRefGoogle ScholarPubMed
Glassock, RJ, Winearls, C. Screening for CKD with eGFR: doubts and dangers. Clin J Am Soc Nephrol 2008;3:1563–8.Google Scholar
Winearls, CG, Glassock, RJ. Classification of chronic kidney disease in the elderly: pitfalls and errors. Nephron Clin Pract 2011;119(Suppl 1):c2–4.Google Scholar
Go, AS, Chertow, GM, Fan, D, et al. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004;351:1296–305.Google Scholar
Henry, RM, Kostense, PJ, Bos, G, et al. Mild renal insufficiency is associated with increased cardiovascular mortality: the Hoorn Study. Kidney Int 2002;62:1402–7.Google Scholar
Deo, R, Fyr, CL, Fried, LF, et al. Kidney dysfunction and fatal cardiovascular disease–an association independent of atherosclerotic events: results from the Health, Aging, and Body Composition (Health ABC) study. Am Heart J 2008;155:62–8.CrossRefGoogle ScholarPubMed
Fried, LF, Katz, R, Sarnak, MJ, et al. Kidney function as a predictor of noncardiovascular mortality. J Am Soc Nephrol 2005;16:3728–35.Google Scholar
Minutolo, R, Lapi, F, Chiodini, P, et al. Risk of ESRD and death in patients with CKD not referred to a nephrologist: a 7-year prospective study. Clin J Am Soc Nephrol 2014;9(9):1586–93.Google Scholar
White, SL, Polkinghorne, KR, Atkins, RC, Chadban, SJ. Comparison of the prevalence and mortality risk of CKD in Australia using the CKD Epidemiology Collaboration (CKD-EPI) and Modification of Diet in Renal Disease (MDRD) Study GFR estimating equations: the AusDiab (Australian Diabetes, Obesity and Lifestyle) Study. Am J Kidney Dis 2010;55(4):660–70.Google Scholar
Briasoulis, A, Bakris, GL. Chronic kidney disease as a coronary artery disease risk equivalent. Current Cardiology Reports 2013;15:340.Google Scholar
de Brito-Ashurst, I, Varagunam, M, Raftery, MJ, Yaqoob, MM. Bicarbonate supplementation slows progression of CKD and improves nutritional status. J Am Soc Nephrol 2009;20:2075–84.Google Scholar
James, PA, Oparil, S, Carter, BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA 2014;311(5):507–20.Google Scholar
Locatelli, F, Del Vecchio, L. Optimizing the management of renal anemia: challenges and new opportunities. Kidney Int Suppl 2008;74:S33–7.Google Scholar
KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl 2009:S1–130.Google Scholar
Anderson, S, Halter, JB, Hazzard, WR, et al. Prediction, progression, and outcomes of chronic kidney disease in older adults. J Am Soc Nephrol 2009;20:1199–209.Google Scholar
Martinez-Ramirez, HR, Jalomo-Martinez, B, Cortes-Sanabria, L, et al. Renal function preservation in type 2 diabetes mellitus patients with early nephropathy: a comparative prospective cohort study between primary health care doctors and a nephrologist. Am J Kidney Dis 2006;47:78–87.Google Scholar
Emamian, SA, Nielsen, MB, Pedersen, JF, Ytte, L. Sonographic evaluation of renal appearance in 665 adult volunteers. Correlation with age and obesity. Acta Radiologica 1993;34:482–5.CrossRefGoogle ScholarPubMed
Thomas, SE, Anderson, S, Gordon, KL, et al. Tubulointerstitial disease in aging: evidence for underlying peritubular capillary damage, a potential role for renal ischemia. J Am Soc Nephrol 1998;9:231–42.Google Scholar
Abrass, CK, Adcox, MJ, Raugi, GJ. Aging-associated changes in renal extracellular matrix. Am J Pathol 1995;146:742–52.Google Scholar
Hoy, WE, Douglas-Denton, RN, Hughson, MD, et al. A stereological study of glomerular number and volume: preliminary findings in a multiracial study of kidneys at autopsy. Kidney Int Suppl 2003:S31–7.Google Scholar
Hollenberg, NK, Adams, DF, Solomon, HS, et al. Senescence and the renal vasculature in normal man. Circ Res 1974;34:309–16.Google Scholar
Kuhlik, F, Epstein, F, Elahi, D, et al. Urinary prostaglandin E2 and dopamine response to water loading in young and elderly humans. Gertatr Nephrol Urol 1995;5:79–83.Google Scholar
Rivas-Cabanero, L, Rodriguez-Barbero, A, Arevalo, M, Lopez-Novoa, JM. Effect of NG-nitro-L-arginine methyl ester on nephrotoxicity induced by gentamicin in rats. Nephron 1995;71:203–7.Google Scholar
Reckelhoff, JF, Manning, RD Jr. Role of endothelium-derived nitric oxide in control of renal microvasculature in aging male rats. American Journal of Physiology 1993;265:R1126–31.Google Scholar
Macias-Nunez, JF, Lopez-Novoa, JM, Martinez-Maldonado, M. Acute renal failure in the aged. Semin Nephrol 1996;16:330–8.Google Scholar
Kleinknecht, D, Landais, P, Goldfarb, B. Pathophysiology and clinical aspects of drug-induced tubular necrosis in man. Contrib Nephrol 1987;55:145–58.Google Scholar
Liano, F, Pascual, J. Epidemiology of acute renal failure: a prospective, multicenter, community-based study. Madrid Acute Renal Failure Study Group. Kidney Int 1996;50:811–8.Google Scholar
Pascual, J, Liano, F. Causes and prognosis of acute renal failure in the very old. Madrid Acute Renal Failure Study Group. J Am Geriatr Soc 1998;46:721–5.Google Scholar
Sands, JM. Urine-concentrating ability in the aging kidney. Sci Aging Knowledge Environ 2003;24:PE15.Google Scholar
Kenney, WL, Chiu, P. Influence of age on thirst and fluid intake. Med Sci Sports Exerc 2001;33:1524–32.Google Scholar
van Kraaij, DJ, Jansen, RW, Gribnau, FW, Hoefnagels, WH. Diuretic therapy in elderly heart failure patients with and without left ventricular systolic dysfunction. Drugs Aging 2000;16:289–300.Google Scholar
Macias Nunez, JF, Garcia Iglesias, C, Bondia Roman, A, et al. Renal handling of sodium in old people: a functional study. Age Ageing 1978;7:178–81.Google Scholar
Cheung, CM, Ponnusamy, A, Anderton, JG. Management of acute renal failure in the elderly patient: a clinician’s guide. Drugs Aging 2008;25:455–76.Google Scholar
Rich, MW, Crecelius, CA. Incidence, risk factors, and clinical course of acute renal insufficiency after cardiac catheterization in patients 70 years of age or older: a prospective study. Archives of Internal Medicine 1990;150:1237–42.Google Scholar
Ivanes, F, Isorni, MA, Halimi, JM, et al. Predictive factors of contrast-induced nephropathy in patients undergoing primary coronary angioplasty. Arch Cardiovasc Dis 2014;107:424–32.Google Scholar
Davidson, CJ, Hlatky, M, Morris, KG, et al. Cardiovascular and renal toxicity of a nonionic radiographic contrast agent after cardiac catheterization: a prospective trial. Ann Intern Med 1989;110:119–24.Google Scholar
Lautin, EM, Freeman, NJ, Schoenfeld, AH, et al. Radiocontrast-associated renal dysfunction: incidence and risk factors. AJR Am J Roentgenol 1991;157:49–58.Google Scholar
Watts, RA, Lane, SE, Bentham, G, Scott, DG. Epidemiology of systemic vasculitis: a ten-year study in the United Kingdom. Arthritis Rheum 2000;43:414–9.Google Scholar
Nachman, PH, Hogan, SL, Jennette, JC, Falk, RJ. Treatment response and relapse in antineutrophil cytoplasmic autoantibody-associated microscopic polyangiitis and glomerulonephritis. J Am Soc Nephrol 1996;7:33–9.Google Scholar
Cole, E, Cattran, D, Magil, A, et al. A prospective randomized trial of plasma exchange as additive therapy in idiopathic crescentic glomerulonephritis. The Canadian Apheresis Study Group. Am J Kidney Dis 1992;20:261–9.Google Scholar
Mekhail, TM, Hoffman, GS. Longterm outcome of Wegener’s granulomatosis in patients with renal disease requiring dialysis. J Rheumatol 2000;27:1237–40.Google Scholar
Jayne, D, Rasmussen, N, Andrassy, K, et al. A randomized trial of maintenance therapy for vasculitis associated with antineutrophil cytoplasmic autoantibodies. N Engl J Med 2003;349:36–44.Google Scholar
Schwartz, CJ, White, TA. Stenosis of renal artery: an unselected necropsy study. BMJ 1964;2:1415–21.Google Scholar
Thadhani, RI, Camargo, CA Jr, Xavier, RJ, et al. Atheroembolic renal failure after invasive procedures. Natural history based on 52 histologically proven cases. Medicine (Baltimore) 1995;74:350–8.Google Scholar
Gupta, BK, Spinowitz, BS, Charytan, C, Wahl, SJ. Cholesterol crystal embolization-associated renal failure after therapy with recombinant tissue-type plasminogen activator. Am J Kidney Dis 1993;21:659–62.Google Scholar
Hyman, BT, Landas, SK, Ashman, RF, et al. Warfarin-related purple toes syndrome and cholesterol microembolization. Am J Med 1987;82:1233–7.Google Scholar
Fukumoto, Y, Tsutsui, H, Tsuchihashi, M, et al. Cholesterol Embolism Study I: the incidence and risk factors of cholesterol embolization syndrome, a complication of cardiac catheterization: a prospective study. J Am Coll Cardiol 2003;42:211–6.Google Scholar
Haas, M, Spargo, BH, Wit, EJ, Meehan, SM. Etiologies and outcome of acute renal insufficiency in older adults: a renal biopsy study of 259 cases. Am J Kidney Dis 2000;35:433–47.Google Scholar
Moutzouris, DA, Herlitz, L, Appel, GB, et al. Renal biopsy in the very elderly. Clin J Am Soc Nephrol 2009;4:1073–82.CrossRefGoogle ScholarPubMed
Groeneveld, AB, Tran, DD, van der Meulen, J, et al. Acute renal failure in the medical intensive care unit: predisposing, complicating factors and outcome. Nephron 1991;59:602–10.Google Scholar
Gentric, A, Cledes, J. Immediate and long-term prognosis in acute renal failure in the elderly. Nephrol Dial Transplant 1991;6:86–90.Google Scholar
Schiffl, H. Renal recovery from acute tubular necrosis requiring renal replacement therapy: a prospective study in critically ill patients. Nephrol Dial Transplant 2006;21:1248–52.Google Scholar
Bhandari, S, Turney, JH. Survivors of acute renal failure who do not recover renal function. QJM 1996;89:415–21.Google Scholar
Liano, F, Felipe, C, Tenorio, MT, et al. Long-term outcome of acute tubular necrosis: a contribution to its natural history. Kidney Int 2007;71:679–86.Google Scholar
Chertow, GM, Soroko, SH, Paganini, EP, et al. Mortality after acute renal failure: models for prognostic stratification and risk adjustment. Kidney Int 2006;70:1120–6.Google Scholar
Feest, TG, Round, A, Hamad, S. Incidence of severe acute renal failure in adults: results of a community based study. BMJ 1993;306:481–3.Google Scholar
Bulpitt, CJ, Beckett, N, Peters, R, et al. Does white coat hypertension require treatment over age 80? Results of the hypertension in the very elderly trial ambulatory blood pressure side project. Hypertension 2013;61:89–94.Google Scholar
Pickering, TG, Hall, JE, Appel, LJ, et al. Recommendations for blood pressure measurement in humans and experimental animals: part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Circulation 2005;111:697–716.CrossRefGoogle Scholar
Cruickshank, JM. Coronary flow reserve and the J curve relation between diastolic blood pressure and myocardial infarction. BMJ 1988;297:1227–30.Google Scholar
Kumar, S, Berl, T. Sodium. Lancet 1998;352:220–8.Google Scholar
Kleinfeld, M, Casimir, M, Borra, S. Hyponatremia as observed in a chronic disease facility. J Am Geriatr Soc 1979;27:156–61.Google Scholar
Liamis, G, Rodenburg, EM, Hofman, A, et al. Electrolyte disorders in community subjects: prevalence and risk factors. Am J Med 2013;126:256–63.Google Scholar
Shapiro, DS, Sonnenblick, M, Galperin, I, et al. Severe hyponatraemia in elderly hospitalized patients: prevalence, aetiology and outcome. Internal Medicine Journal 2010;40:574–80.Google Scholar
Bigaillon, C, El Jahiri, Y, Garcia, C, et al. [Inappropriate ADH secretion-induced hyponatremia and associated with paroxetine use]. Rev Med Interne 2007;28:642–4.Google Scholar
Kim, CS, Choi, JS, Bae, EH, Kim, SW. Hyponatremia associated with bupropion. Electrolyte Blood Press 2011;9:23–6.Google Scholar
Rodenburg, EM, Hoorn, EJ, Ruiter, R, et al. Thiazide-associated hyponatremia: a population-based study. Am J Kidney Dis 2013;62:67–72.Google Scholar
Renneboog, B, Musch, W, Vandemergel, X, et al. Mild chronic hyponatremia is associated with falls, unsteadiness, and attention deficits. Am J Med 2006;119:71 e1–8.Google Scholar
Gankam Kengne, F, Andres, C, Sattar, L, et al. Mild hyponatremia and risk of fracture in the ambulatory elderly. QJM 2008;101:583–8.Google Scholar
Barsony, J, Sugimura, Y, Verbalis, JG. Osteoclast response to low extracellular sodium and the mechanism of hyponatremia-induced bone loss. J Biol Chem 2011;286:10864–75.Google Scholar
Tseng, CK, Lin, CH, Hsu, HS, et al. In addition to malnutrition and renal function impairment, anemia is associated with hyponatremia in the elderly. Arch Gerontol Geriatr 2012;55:77–81.Google Scholar
Hawkins, RC. Age and gender as risk factors for hyponatremia and hypernatremia. Clin Chim Acta 2003;337:169–72.Google Scholar
Borra, SI, Beredo, R, Kleinfeld, M. Hypernatremia in the aging: causes, manifestations, and outcome. J Natl Med Assoc 1995;87:220–4.Google Scholar
Dinsdale, C, Wani, M, Steward, J, O’Mahony, MS. Tolerability of spironolactone as adjunctive treatment for heart failure in patients over 75 years of age. Age Ageing 2005;34:395–8.Google Scholar
Passarelli, MC, Jacob-Filho, W, Figueras, A. Adverse drug reactions in an elderly hospitalised population: inappropriate prescription is a leading cause. Drugs Aging 2005;22:767–77.Google Scholar
Bowling, CB, Pitt, B, Ahmed, MI, et al. Hypokalemia and outcomes in patients with chronic heart failure and chronic kidney disease: findings from propensity-matched studies. Circ Heart Fail 2010;3:253–60.Google Scholar
USRD. USRDS 2013 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 2013. Available at: www.usrds.org/2013/pdf/v1_00_intro_13.pdf (accessed 14 November 2015).Google Scholar
Cooper, BA, Branley, P, Bulfone, L, et al. A randomized, controlled trial of early versus late initiation of dialysis. N Engl J Med 2010;363:609–19.Google Scholar
Steinman, TI. The older patient with end-stage renal disease: is chronic dialysis the best option? Semin Dial 2012;25:602–5.Google Scholar
Couchoud, C, Labeeuw, M, Moranne, O, et al. A clinical score to predict 6-month prognosis in elderly patients starting dialysis for end-stage renal disease. Nephrol Dial Transplant 2009;24:1553–61.Google Scholar
Moss, AH. Revised dialysis clinical practice guideline promotes more informed decision-making. Clin J Am Soc Nephrol 2010;5:2380–3.Google Scholar
O’Hare, AM. Vascular access for hemodialysis in older adults: a “patient first” approach. J Am Soc Nephrol 2013;24:1187–90.Google Scholar
DeSilva, RN, Patibandla, BK, Vin, Y, et al. Fistula first is not always the best strategy for the elderly. J Am Soc Nephrol 2013;24:1297–304.Google Scholar
Abdullah, BJ, Mohammad, N, Sangkar, JV, et al. Incidence of upper limb venous thrombosis associated with peripherally inserted central catheters (PICC). British Journal of Radiology 2005;78:596–600.Google Scholar
OPTN/SRTR 2012 Annual Data Report. Rockville, MD: Department of Health and Human Services, Health Resources and Services Administration 2014. Available at: http://onlinelibrary.wiley.com/doi/10.1111/ajt.v14.s1/issuetoc (accessed 14 November 2015).Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×