In a recent article published in the Canadian Medical Association Journal (CMAJ), the issue of why Chronic Kidney Disease (CKD) affects up to 40% of the older population in Canada and other affluent nations is explored.


Older Canadian affected by kidney disease

Patients over 75 years old have started dialysis at the quickest rate during the past forty years. More than half of patients beginning dialysis in Canada are 65 years of age or older.  

Asad Ali Merchant and Erick Ling, two researchers at the University Health Network's Department of Family and Community Medicine at the University of Toronto, are the authors of the study.

The authors claimed that data collected over more than 22 years, starting in 2000, served as the foundation for their study.

"To find original research and review publications on chronic kidney disease in older persons published between January 2000 and March 2022, we did a focused search of MEDLINE". Elderly, geriatrics, advance care planning, chronic kidney disease, blood pressure, and management were search phrases associated with the medical subject title. 


Study Conclusions

One of the study's major conclusions was that reno-cardiovascular risk factors, external trauma, and physiologic age-related declines in kidney function can all combine to cause chronic kidney disease in older persons.

Another conclusion was that fragile individuals who were at risk for polypharmacy—the routine use of five or more medications—should have less aggressive aims taken into account while managing risk factors for CKD.


In order to screen for kidney disease in high-risk groups, such as those with hypertension, Type-2 diabetes mellitus, or cardiovascular disease, the report advised doctors to perform yearly testing. 

Urinalysis and ultrasonography should be conducted in addition to further testing when patients show signs of new or worsening kidney failure.

The authors concluded by stating that further study is necessary to understand the long-term implications of CKD.

Geriatric competencies must be used in the management of elderly patients. Primary care physicians and nephrologists can follow a nuanced and holistic approach to care while respecting patients' objectives and values if they are aware of how CKD impacts older people, according to the paper. 

Future studies should fill in information gaps about the optimum treatment for elderly patients with end-stage renal disease who choose not to begin dialysis, optimal blood pressure objectives, and symptom management.