Study in the Canadian Medical Association Journal examines increasing incidence of kidney disease
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A new report in the Canadian Medical Association Journal (CMAJ) is examining the problem of why Chronic Kidney Disease (CKD) is affecting as many as 40 per cent of the elderly population in Canada and other developed countries.
Over the last four decades, patients older than 75 years are the fastest-growing group to start dialysis. In Canada, more than half of patients starting dialysis are 65 years or older.
The authors of the report are Asad Ali Merchant and Erick Ling; both are scientists with the Nephrology Division, University Health Network, University of Toronto; Department of Family and Community Medicine.
The authors said their research was based on data gathered over more than 22 years, going back to 2000.
“We conducted a targeted search of MEDLINE to identify original research and review articles on chronic kidney disease in older adults published from January 2000 through March 2022. Medical subject heading search terms included “elderly,” “geriatrics,” “advance care planning,” “chronic kidney disease,” “blood pressure” and “management.”
Some of the key findings in the research were that chronic kidney disease in older adults can result from a combination of physiologic, age-related decline in kidney function, reno-cardiovascular risk factors and external injuries.
Another finding was that management of risk factors for CKD should be individualized with consideration of less aggressive targets for frail patients at risk of polypharmacy (the regular use of five or more medications).
The report recommended that physicians should order annual testing to screen for kidney disease in high-risk populations such as those with hypertension, Type-2 diabetes mellitus or cardiovascular disease.
In cases where patients demonstrate new or worsening kidney dysfunction, additional tests along with urinalysis and ultrasound should be ordered.
In conclusion the authors wrote that more research is required into the longer term effects of CKD.
“Management of older patients must incorporate geriatric competencies. By appreciating how CKD affects older patients, primary care providers and nephrologists can pursue a nuanced and holistic approach to care, while respecting patients’ goals and values,” said the report.
“Future research should address gaps in knowledge about optimal blood pressure targets, symptom management and best care for older patients with end-stage renal disease who decide not to start dialysis.”
A complete text copy of the report is available online here.