Park Yohan, Hwang Won Min
Division of Nephrology, Department of Internal Medicine, Konyang University Hospital, College of Medicine, Konyang University, Daejeon, Korea.
Yonsei Med J. 2025 Feb;66(2):63-74. doi: 10.3349/ymj.2024.0178.
Chronic kidney disease (CKD) is highly prevalent among elderly patients, and as the global population ages, the number of elderly patients with CKD is increasing. Elderly patients require additional considerations beyond those required for their younger counterparts, such as comorbidities, frailty, and geriatric syndromes. In this review, we primarily focus on these additional considerations specific to elderly patients and discuss the assessment of CKD and its management strategies, including blood pressure and glycemic control; dyslipidemia, anemia, and electrolyte and metabolic acidosis management; and medication dosage, among others, as well as polypharmacy and nonpharmacological management. Furthermore, the concept of conservative kidney management and the practical recommendations of the Korean Society of Geriatric Nephrology for elderly patients with end-stage kidney disease requiring dialysis therapy are discussed. In particular, the aging rate in Korea is exceptionally high; therefore, it is crucial to pay more attention to the increase in elderly patients with CKD. A more palliative approach, rather than intensive treatment strategies, may be necessary for these patients. In a world with an abundance of information, shared decision-making with patients is of great importance, and it is essential to keep in mind that this holds true for elderly patients as well.
慢性肾脏病(CKD)在老年患者中极为普遍,并且随着全球人口老龄化,老年CKD患者的数量正在增加。老年患者除了需要考虑年轻患者所需的因素外,还需要额外考虑其他因素,如合并症、衰弱和老年综合征。在本综述中,我们主要关注老年患者特有的这些额外因素,并讨论CKD的评估及其管理策略,包括血压和血糖控制;血脂异常、贫血以及电解质和代谢性酸中毒的管理;药物剂量等,以及多重用药和非药物管理。此外,还讨论了保守肾脏管理的概念以及韩国老年肾脏病学会对需要透析治疗的终末期肾病老年患者的实际建议。特别是,韩国的老龄化速度异常之高;因此,更加关注老年CKD患者数量的增加至关重要。对于这些患者,可能需要一种更姑息的方法,而不是强化治疗策略。在一个信息丰富的世界里,与患者共同决策非常重要,并且必须牢记这对老年患者同样适用。