From the Guidelines
Chronic Kidney Disease (CKD) stage 3 is not caused solely by old age, although age is a significant risk factor. While kidney function naturally declines with age at a rate of about 1% per year after age 40, this normal aging process alone typically doesn't cause CKD stage 3 1. The development of CKD stage 3 (defined as an estimated glomerular filtration rate between 30-59 ml/min/1.73m²) usually requires additional factors beyond normal aging. Common causes include:
- Diabetes
- Hypertension
- Glomerulonephritis
- Polycystic kidney disease
- Recurrent kidney infections
- Certain medications like NSAIDs or nephrotoxic antibiotics
Older adults are more vulnerable to kidney damage because they often have multiple risk factors, reduced kidney reserve, and age-related structural changes in the kidneys. Management focuses on treating underlying conditions, controlling blood pressure (often with ACE inhibitors or ARBs), managing diabetes, avoiding nephrotoxic medications, and lifestyle modifications including a kidney-friendly diet, regular exercise, and smoking cessation. Regular monitoring of kidney function is essential, especially in older adults with risk factors. According to the guidelines, persons with CKD are more likely to have a cardiovascular event than to progress to end-stage renal disease, and have worse prognosis with higher mortality rates after acute myocardial infarction 1.
The CKD classification system now encompasses cause of CKD, GFR category, and albuminuria category, which provides a framework for reporting and research in CKD 1. Whether decreased GFR or increased albuminuria in older persons represents a disease or “normal aging” will always be debatable, and disease labeling will continue to provoke controversy in an aging society. However, it is essential to identify and manage CKD in older adults to prevent progression and reduce the risk of cardiovascular events.
In terms of management, the guidelines recommend treating underlying conditions, controlling blood pressure, and managing diabetes, as well as avoiding nephrotoxic medications and lifestyle modifications 1. Regular monitoring of kidney function is essential, especially in older adults with risk factors. The guidelines also recommend referral to a specialist for consultation and comanagement if the patient's personal physician cannot adequately evaluate and treat the patient, especially for patients with a GFR less than 30 mL/min per 1.73 m² 1.
Overall, CKD stage 3 is a complex condition that requires a comprehensive approach to management, including treating underlying conditions, controlling blood pressure, and managing diabetes, as well as avoiding nephrotoxic medications and lifestyle modifications. Regular monitoring of kidney function is essential, especially in older adults with risk factors, to prevent progression and reduce the risk of cardiovascular events.
From the Research
Chronic Kidney Disease (CKD) Stage 3 and Old Age
- CKD stage 3 can be caused by various factors, including old age, as the risk of CKD increases with age 2, 3.
- A study conducted in Beijing found that the prevalence of CKD increased with age, with 10.0% of subjects aged 18-39,14.2% of subjects aged 40-59,20.8% of subjects aged 60-69, and 30.5% of subjects older than 70 years having CKD 2.
- Another study found that age was an independent predictive factor for developing CKD, with an odds ratio of 1.08 per year 3.
- However, it is essential to note that CKD stage 3 can also be caused by other factors, such as hypertension, diabetes, and nephrotoxic medications, and that old age is not the sole cause of CKD stage 3 4, 5, 6.
Risk Factors for CKD Progression
- Hypertension and diabetes are established drivers of CKD progression, and efforts to slow CKD progression should target both patients with hypertension and diabetes 5.
- A study found that the strongest risk factors for CKD progression were low eGFR and albuminuria, even at mild-moderate levels 5.
- Another study found that the prevalence of CKD increased among U.S. adults from 1988-1994 to 1999-2004, and that improvements in hypertension and high cholesterol management have been offset by both diagnosed and undiagnosed diabetes 6.
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CKD and Aging Population
- The HIV population is aging and increasingly facing illnesses typically seen in the elderly, such as CKD 3.
- A retrospective longitudinal study found that the prevalence of CKD at baseline was 5.1%, and that 2.15% of HIV-positive individuals examined without CKD at baseline developed CKD 3.
- The study also found that age was an independent predictive factor for developing CKD, with an odds ratio of 1.08 per year 3.