In Reply to ‘CKD in the Elderly’
Article Outline
Drs Glassock and Winearls1 do not question the high prevalence of markers of kidney damage or decreased estimated glomerular filtration rate in the elderly. However, they question the purpose of asserting that so many elderly individuals have a disease.
Although chronic kidney disease (CKD) is not as severe a disease as kidney failure, it is still a serious health concern. This issue was considered at the Kidney Disease: Improving Global Outcomes (KDIGO) consensus conference.2 Although alternative proposals were considered, the decision by the international group was to retain the term “disease.”
The KDOQI definition of CKD as a ‘disease’ is consistent with current usage of this term. The Oxford English Dictionary (Compact Edition) defines a disease as ‘A disorder of structure or function in a human, animal, or plant, especially one that produces specific symptoms.' The use of the term ‘disease’ in CKD is consistent with: (a) the need for action to improve outcomes through prevention, detection, evaluation and treatment; (b) providing a message for public, physician and patient education programs; (c) common usage; (d) and its use in other conditions defined by findings and laboratory tests, such as hypertension, diabetes, and hyperlipidemia.
Are Drs Glassock and Winearls correct that “Physicians already handle the elderly with care; this ‘disease’ prompt is unnecessary”?1 We suspect that there is still inadequate attention to CKD in the elderly. Documentation of the wide range of complications by level of glomerular filtration rate, markers of kidney damage, and risk factors, including age, is only beginning.3 Of course, not all elderly patients with CKD develop kidney failure. However, defining only those who later experience progression as having “true CKD” asks clinicians to delay making the diagnosis of CKD until the adverse complications have already occurred. Let us not turn away from the problem of CKD in the elderly. When we have preventive strategies and treatments for the development, progression, and complications of CKD, we can more confidently state that we handle the elderly with care.
Acknowledgements
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Financial Disclosure: None.
References
- . CKD in the elderly. Am J Kidney Dis. 2008;52:803;(letter)
- Chronic kidney disease as a global public health problem: Approaches and initiatives—A position statement from Kidney Disease Improving Global Outcomes (KDIGO). Kidney Int. 2007;72:247–259
- All-cause mortality attributable to chronic kidney disease (CKD): A prospective cohort study based on 462 293 adults in Taiwan. Lancet. 2007;371:2173–2182
PII: S0272-6386(08)01182-7
doi:10.1053/j.ajkd.2008.07.016
© 2008 National Kidney Foundation, Inc. Published by Elsevier Inc All rights reserved.
Refers to article:
- CKD in the Elderly
