Chronic kidney disease in Taiwan's aging population: something far more than a distant ship's smoke on the horizon.

Abstract

Taiwan had the highest prevalence of end-stage renal disease (ESRD) for more than a decade, and the incidence, although ranked first prior to 2009, has fallen behind that of the USA recently. Older people constitute about half of incident dialysis patients in Taiwan. A large Taiwanese cohort study showed that the prevalence of chronic kidney disease (CKD) is high (11.9%) in adults, and the prevalence is even higher (37.2%) among the elderly. Using the health insurance dataset, old age has been proved to be a significant risk factor of developing CKD, especially in rural areas where there is a larger proportion of older people and have a higher incidence of ESRD in Taiwan. It is known that glomerular filtration rate (GFR) decreases in parallel with age, accompanied by both structural and physiological changes, including a loss of renal mass, reduced renal blood flow, and impairment of autoregulation, sodium and potassium handling, as well as diluting and concentrating ability. The diminished renal reserve in the elderly results in the vulnerability of the kidney to various insults. Delayed diagnosis of kidney disease in the elderly potentially inflicts further damage and