Chronic kidney disease and the aging population

Abstract

THE PROPORTION OF OLDER PEOPLE in the general population is steadily increasing worldwide, with the most rapid growth in low- and middle-income countries (27). This demographic change is to be celebrated, because it is the consequence of socioeconomic development and better life expectancy. However, population aging also has important implications for society, in diverse areas including health systems, labor markets, public policy, social programs, and family dynamics (26). A successful response to the aging population will require capitalizing on the opportunities that this transition offers, as well as effectively addressing its challenges. Chronic kidney disease (CKD) is an important public health problem that is characterized by poor health outcomes and very high health care costs. CKD is a major risk multiplier in patients with diabetes, hypertension, heart disease, and stroke, all of which are key causes of death and disability in older people (5). Since the prevalence of CKD is higher in older people, the health impact of population aging will depend in part on how the kidney community responds. March 13, 2014, will mark the celebration of the 9 th World Kidney Day (WKD), an annual event jointly sponsored by the International Society of Nephrology and the International Federation of Kidney Foundations. Since its inception in 2006, WKD has become the most successful effort to raise awareness among policymakers and the general public about the importance of kidney disease. The topic for WKD 2014 is “CKD in older people.” This article reviews the key links between kidney function, age, health, and illness and discusses the implications of the aging population for the care of people with CKD. Epidemiology of Aging The key drivers of population aging are socioeconomic development and increasing prosperity, which result in lower perinatal, infant and childhood mortality; lower risk of death in early adulthood due to accidents and unsafe living conditions; and improving survival of middle-aged and older people due to chronic disease. The resulting increases in life expectancy (together with the lower birth rates that typically accompany socioeconomic development) mean that older people account for a larger proportion of the general population (27). The extent of the resulting changes in population characteristics can be startling, especially for developing countries (Fig. 1). In contrast to the situation even two generations ago, people can expect to live for many years after the usual retirement age. For example, UK men and women aged 65 yr in 2030 can expect to live until age 88 and 91 years, respectively (22). Predicted life expectancy for today’s children is controversial, but experts estimate that 50% of UK children born in 2007 will live to at least 103 yr (22). Although it is clear that people are living longer, it is uncertain how much of the increased life expectancy will translate into years of good health. These demographic changes have dramatic potential implications for conditions such as CKD, for which the prevalence increases with age.