There is a rise in the number of elderly people and those with chronic
kidney disease (CKD) in the United States. Despite the high prevalence of CKD in the
elderly, most will die before renal replacement therapy (RRT), as CKD itself, is an
independent risk for death. Control of modifiable risk factors such as proteinuria and
hypertension may retard disease progression in this population, however, in those who
do progress to stage 5, options for RRT include hemodialysis (HD), peritoneal dialysis
(PD), kidney transplantation and conservative (medical) management. Special
problems in the elderly with CKD include those inherent to the patient and those
related to limited resources. Inherent to the elderly patient with CKD is the problem of
accurately measuring estimated glomerular filtration rate (eGFR), frailty, depression,
cognitive decline, limited autonomy, heart failure and arterio-venous fistula maturation
issues. Problems with resources include but are not limited to: a paucity of evidencebased
literature due to exclusion of the elderly from large clinical trials and scarce
resources like kidney transplantation. Best clinical practices are personalized to the
individual patient and should balance risk factors, patient autonomy and available
resources
Keywords: Chronic kidney disease, Conservative therapies, Elderly, Estimated
glomerular filtration rate, Home-based therapy, Initiation of renal replacement
therapy, Kidney transplant, Prevalence, Quality of life, Renal replacement
therapy.
