Kidney disease in the elderly

Chronic kidney disease (CKD) and acute kidney injury (AKI) are more common in the elderly due to ageing-related changes in the kidney. Renal pathology in the elderly will in future form an increasing proportion of the workload of nephrologists, specialists in internal medicine and general practitioners due to ageing of the general population. AKI in the elderly can often be anticipated and prevented. Published guidelines concerning the management of CKD in younger adults may not be universally implementable in the elderly, and may ignore complications and challenges specific to this age group. There is a growing demand for renal services to provide renal replacement therapy (RRT) to elderly patients. The decision to start an elderly person on a particular form of RRT should follow careful assessment of their biological age, function and lifestyle, and their health priorities and quality of life must be kept at the centre of decision-making at all times. Patients who are unsuited to or do not wish to commence RRT may do very well with maximal conservative management (MCM). End-of-life and palliative care remains somewhat underused in nephrology, and is an area that needs to be developed further.