Diabetic kidney disease in the older adult: an update

Abstract

The kidneys are among the most prominent body organs affected by the process of aging, as both kidney morphology and function are known to change with age. However, special challenges emerge when the elderly patient also has diabetes complicated by kidney disease. Cases frequently progress from the early stages of diabetic nephropathy to advanced kidney impairment and end-stage renal disease, and the majority of patients suffer cardiovascular complications. However, many elderly patients with diabetes will lack the classic clinical features of diabetic kidney disease. Neither the efficacy nor safety of general treatment goals such as glycemic control, hypertension management and renin–angiotensin blockade have been adequately addressed in the aging diabetic kidney patient. These basic treatments for diabetic kidney disease are extrapolated from studies of mostly middle-aged individuals. Diabetic kidney guidelines do not adequately distinguish between age groups. Aggressive management must be measured against life expectancy in the elderly. The physician should be aware of these risks. Unfortunately, many elderly diabetic chronic kidney disease/end-stage renal disease patients are not prescribed the treatments that are available. Over a third of new end-stage renal disease cases among the elderly are due to diabetic kidney disease. Prognosis is poor, even for those who receive a kidney transplant.