Alfano Gaetano, Perrone Rossella, Fontana Francesco, Ligabue Giulia, Giovanella Silvia, Ferrari Annachiara, Gregorini Mariacristina, Cappelli Gianni, Magistroni Riccardo, Donati Gabriele
Nephrology Dialysis and Transplant Unit, University Hospital of Modena, 41124 Modena, Italy.
General Medicine and Primary Care, University of Modena and Reggio Emilia, 41124 Modena, Italy.
Life (Basel). 2022 Oct 28;12(11):1724. doi: 10.3390/life12111724.
The process of aging population will inevitably increase age-related comorbidities including chronic kidney disease (CKD). In light of this demographic transition, the lack of an age-adjusted CKD classification may enormously increase the number of new diagnoses of CKD in old subjects with an indolent decline in kidney function. Overdiagnosis of CKD will inevitably lead to important clinical consequences and pronounced negative effects on the health-related quality of life of these patients. Based on these data, an appropriate workup for the diagnosis of CKD is critical in reducing the burden of CKD worldwide. Optimal management of CKD should be based on prevention and reduction of risk factors associated with kidney injury. Once the diagnosis of CKD has been made, an appropriate staging of kidney disease and timely prescriptions of promising nephroprotective drugs (e.g., RAAS, SGLT-2 inhibitors, finerenone) appear crucial to slow down the progression toward end-stage kidney disease (ESKD). The management of elderly, comorbid and frail patients also opens new questions on the appropriate renal replacement therapy for this subset of the population. The non-dialytic management of CKD in old subjects with short life expectancy features as a valid option in patient-centered care programs. Considering the multiple implications of CKD for global public health, this review examines the prevalence, diagnosis and principles of treatment of kidney disease in the aging population.
人口老龄化进程将不可避免地增加包括慢性肾脏病（CKD）在内的与年龄相关的合并症。鉴于这种人口结构转变，缺乏年龄调整的CKD分类可能会极大地增加肾功能缓慢下降的老年受试者中CKD的新诊断数量。CKD的过度诊断将不可避免地导致重要的临床后果，并对这些患者的健康相关生活质量产生明显的负面影响。基于这些数据，对CKD进行适当的检查对于减轻全球CKD负担至关重要。CKD的最佳管理应基于预防和减少与肾损伤相关的危险因素。一旦确诊CKD，对肾脏疾病进行适当分期并及时开具有效的肾保护药物（如RAAS、SGLT-2抑制剂、非奈利酮）的处方对于减缓向终末期肾病（ESKD）的进展似乎至关重要。老年、合并症和体弱患者的管理也为该人群的适当肾脏替代治疗带来了新问题。对于预期寿命较短的老年受试者，CKD的非透析管理是患者中心护理计划中的一个有效选择。考虑到CKD对全球公共卫生的多重影响，本综述探讨了老年人群中肾脏疾病的患病率、诊断和治疗原则。
