Abstract
As the world population ages, an expected increase in the prevalence of chronic kidney disease (CKD) among older individuals will pose a considerable challenge for health care systems in terms of resource allocation for disease management. Treatment strategies for older patients with CKD should ideally align with those applied to the general population, focusing on minimizing cardiovascular events and reducing the risk of progression to kidney failure. Emerging therapies, such as SGLT-2 inhibitors and GLP-1 receptor agonists, hold promise for the effective management of CKD in older individuals. In addition, non-pharmacological interventions such as nutritional and exercise therapies have a crucial role. These interventions enhance the effects of pharmacotherapy and, importantly, contribute to the maintenance of cognitive function and overall quality of life. Various factors beyond age and cognitive function must be taken into account when considering kidney replacement therapy for patients with kidney failure. Importantly, all treatment options, including dialysis, transplantation and conservative management approaches, should be tailored to the individual through patient-centred decision-making. The dynamic integration of digital technologies into medical practice has the potential to transform the management of CKD in the aging population.
Key points
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Aging is an important risk factor for chronic kidney disease (CKD); the expected increase in CKD prevalence with the aging population will likely pose a challenge to health care systems in terms of resource allocation and strategies for effective disease management.
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Structural and functional changes that occur in the kidney with aging are associated with a decline in kidney function from around 40 years of age; although these changes vary considerably between individuals, diseases such as hypertension and diabetes accelerate this decline.
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Older patients with CKD should be treated the same way as other members of the general population, with the goal of minimizing cardiovascular events and slowing progression to kidney failure; available evidence suggests that SGLT-2 inhibitors and GLP-1 receptor agonists may be effective in older populations and associated with a low risk of adverse events.
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Nutritional and exercise therapies are essential non-pharmacological treatments for older patients with CKD; these therapies not only enhance the effects of pharmacotherapies but may also help to maintain cognitive function and quality of life.
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Choice of kidney replacement therapy for patients with kidney failure should not solely depend on age or cognitive function; alongside dialysis and transplantation, conservative treatment options, including conservative kidney management, should be considered through patient-centred decision making.
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Digital technologies using wearable devices and virtual reality systems are expected to facilitate the treatment of CKD in older populations.
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S.K. and N.K. developed the scope of the article, and S.K. drafted it. H.K. specifically supported the description of items related to CKM. All authors contributed to researching data for the article, participated in discussions of the content, and reviewed and edited the manuscript before submission.
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S.K. has received research funding from Boehringer Ingelheim. N.K. has received lecture fees from Astellas, AstraZeneca, Kyowa-Kirin, Novartis and Otsuka; research funding from AstraZeneca, Daiichi Sankyo, Kyowa-Kirin, Novartis and Otsuka; and has served as an adviser for Kyowa-Kirin and Novartis. H.K. declares no competing interests.
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Kishi, S., Kadoya, H. & Kashihara, N. Treatment of chronic kidney disease in older populations. Nat Rev Nephrol (2024). https://doi.org/10.1038/s41581-024-00854-w
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DOI: https://doi.org/10.1038/s41581-024-00854-w
