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Kidney Doctor

Geriatric Nephrology

The projected numbers of elderly individuals (defined here as age >65 years) over the next few decades is potentially overwhelming. Aging is a slow, inflammatory biologic process that affects many organs, including kidney. Aging is associated with a decline in renal function. These changes begin in the fourth decade of life and accelerate between the fifth and sixth decades. Nearly 45% of elderly subjects have chronic kidney disease in the United States compared with only 8% of the overall adult population. In general, aging-associated renal injury is worse in men, in obesity, or in the setting of endothelial dysfunction, and aging changes can be retarded with protein or calorie restriction or blockade of the renin-angiotensin system (RAS).
Kidney related problems associated with aging:
Hypertension- Aging is associated with both impaired sodium excretion of a salt load and defective conservation in the setting of sodium restriction. This predisposes to the development of hypertension. After the age of 60 years, most of the population is hypertensive.
Electrolyte and water imbalance- There is impaired water handling with aging. Both concentration and dilution are affected, and nocturia is common. This can predispose an elderly to dehydration and hypernatremia.
Calcium abnormality- Elderly women have lower calcium absorption and lower vitamin D levels.
Anemia- Erythropoietin levels are low in elderly leading to anemia.
There is an increased frequency of renovascular and atheroembolic disease with aging.
Obstructive uropathy- In an elderly male, because of prostatic hyper- trophy and urinary calculi with age, there is an increased risk of asymptomatic bacteriuria and symptomatic urinary tract infection.
Transient urinary incontinence is very common in the elderly with multiple potentially treatable causes.
Elderly subjects are prone to increased kidney damage following medication (NSAIDs, cyclooxygenase 2 inhibitors, aminoglycosides, radiocontrast media, and chemotherapy). Drug dosing needs to be carefully adjusted in the aging patient.
Hence elderly kidney disease patients experience a high rate of complications such as cardiovascular disease, anemia, hypertension, malnutrition, and bone disease. The obstacles to effectively caring for these issues also increase. At KCC we navigate these challenges and coordinate the care of these highly complex elderly patients.
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