Chronic kidney disease and end-stage renal disease in the elderly population: current prevalence, future projections, and clinical significance

Abstract

The world's population is aging, with the number of older adults projected to increase dramatically over the next 2 decades. This trend poses major challenges to health care systems, reflecting the greater health care use and more comorbid conditions among elderly adults. Chronic kidney disease (CKD) is a substantial concern in the elderly population, with both an increasing incidence of treated kidney failure with dialysis as well as a high prevalence of earlier stages of CKD. Given the high burden of risk factors for CKD, the high prevalence of CKD in the elderly population is not surprising, with the rise in obesity, diabetes, and hypertension in middle-aged adults likely foreshadowing further increases in CKD prevalence among the elderly population. It is now commonly agreed that the presence of CKD identifies a higher risk state in the elderly population, with increased risk for multiple adverse outcomes, including kidney failure, cardiovascular disease, cognitive impairment, and death. Accordingly, CKD in older adults is worthy of attention by both health care providers and patients, with the presence of a reduced glomerular filtration rate or albuminuria in the elderly potentially informing therapeutic and diagnostic decisions for these individuals.

Figure 1

Concept model of factors modifying the prevalence of CKD in late life. GFR, glomerular filtration rate.

Figure 2

Prevalence of chronic conditions among adults by age in 2002–2003

Figure 3

Distribution of estimated GFR and chronic kidney disease (CKD) prevalence by age in NHANES 1999–2004. MDRD and CKD-EPI refer to the MDRD Study and CKD-EPI equations, respectively. Reprinted with permission [20].

Figure 4

Proportion of prevalent dialysis patients in the US treated with peritoneal dialysis in 2007.

Figure 5

Incident (A) and prevalent (B) hemodialysis and peritoneal dialysis patients in the United States over the past 10 years. Incidence and prevalence rates for patients between age 20 and 60 have remained stable at 37.7–38.8% and 44.3–45.1%, respectively, over this decade. Figures A and B are derived using data supplied by the USRDS RenDER

Figure 6

Cardiovascular and all-cause mortality in the general population and dialysis population. Data on dialysis patients was derived from the USRDS 2008 Annual Data Report and reflects events occurring between 2001 and 2006; while data on the general population was derived from the 2008 National Vital Statistics Reports using 2005 data; CVD mortality includes death due to myocardial infarction, pericarditis, atherosclerotic coronary disease, cardiomyopathy, cardiac arrhythmia, cardiac arrest, valvular heart disease, pulmonary edema, congestive heart failure and cerebrovascular diseases in dialysis patients and is defined by ICD-10 codes I00–I78 in the general population. The youngest age group in the general population is 25–44 years old versus 20–44 in dialysis.