Hypertension and Chronic Kidney Disease in the Elderly

Although age-related alterations in the structure and function of the kidney may be inevitable, up to one-third of the older population shows no age-related decline in kidney function. As measured by inulin clearance, the healthy elderly population will be able to maintain a normal, albeit lower than their younger counterparts, glomerular filtration rate. This age-related decline in glomerular filtration rate will remain clinically insignificant in the absence of acute or chronic conditions adversely affecting kidney function or reserve. The contribution of illnesses associated with aging, such as hypertension (HTN) and diabetes mellitus, may accelerate this decline in kidney function with aging and therefore increase the incidence of chronic kidney disease. With the predicted global increase in the elderly population, the effect on health care costs and on society in general will be enormous. This will require intensive efforts at controlling diseases, such as HTN, along with continued efforts at promoting increased aerobic exercise, and a low sodium, low fat diet. The age-related decline in kidney function will, in turn, affect not only the choice of therapeutic agent in the treatment of HTN but the dosing and need for combination therapy as well. Although these approaches will need to be as aggressive as possible, they will also need to be balanced with the individual patient's potential for adverse outcomes such as orthostatic hypotension, worsening kidney function, and hyperkalemia (depending upon the agent chosen).