Chronic Kidney Disease in Older Adults. Consensus Statement of Russian Association of Gerontologists and Geriatricians, Scientific Society of Nephrologists of Russia and Eurasian Association of Therapists

Abstract

The prevalence of chronic kidney disease (CKD) increases with age, but CKD is often underdiagnosed in older adults and regarded as age-related changes of kidney function. Screening for CKD is mandatory in older adults and should include estimated glomerular filtration rate (eGFR) using both the CKD EPI creatinine-based formula and the albumin/creatinine ratio in a urine spot sample. In older adults the diagnostic criteria of CKD are the same as in younger subjects. CKD is associated with advanced ageing and requires careful assessment of geriatric syndromes. Renal function should be assessed at least annually, considering a rate of decline in eGFR greater than 1 ml/min/1.73 m2 per year as significant. Older adults with CKD are characterized by high comorbidity; risk factors for CKD and geriatric syndromes overlap. CKD should be considered among a number of comorbid conditions that increase the risk of deterioration of geriatric status and underline the need for multidisciplinary management based on a comprehensive geriatric assessment. Patients with eGFR <60 ml/min/1.73 m2 should be considered at high risk for renal and extrarenal adverse drug effects. In these patients, inappropriate medications, supplements, and vitamins should be carefully identified and corrected using STOPP/START criteria. eGFR and estimated creatinine clearance should be carefully monitored during treatment with drugs that can potentially affect renal function and/or the dose of which is adjusted based on renal function, as well as during acute illness or exacerbation of chronic conditions.