Chronic Kidney Disease in the Elderly - Who Has it? Who Does One Treat and How are They to be Treated?

The prevalence of CKD in the elderly is rising worldwide with the potential for tremendous individual and societal burdens. Accurate diagnosis of CKD by GFR estimation equations is improving, with refinements to diagnosis and prognosis achieved with quantification of albuminuria. Increasing scientific discovery of the causes of kidney senescence and eventual development of strategies to reduce progressive renal loss will be key elements of nephrologic care in the future. Management of the failing kidney of elderly patients requires thoughtful consideration and planning. Determination of illness trajectory, functional status, as well as establishing goals of care are essential considerations for the caring nephrologist. Nephrologists should be aware of the risks and benefits of renal replacement therapy and how to implement conservative and palliative care in treatment of elderly patients with advancing renal disease.