scholarly journals Structural and functional changes in the kidneys and their effect on cardiovascular risk in elderly patients

2020 ◽  
Vol 43 (4) ◽  
pp. 539-548
Author(s):  
Natalya I. Golovina ◽  
◽  
Yury A. Lykov ◽  
Keyword(s):  
Chronic Kidney Disease ◽  
Cardiovascular Risk ◽  
Kidney Disease ◽  
Elderly Patients ◽  
Structural Changes ◽  
Interstitial Fibrosis ◽  
The Elderly ◽  
Functional Changes ◽  
Age Related ◽  
Organ Systems

Like other organ systems, the kidneys also go through process of normal senescence, including both anatomical and physiological changes. Normal physiological aging is characterized by the expected age-related changes in the kidneys. With age, the kidneys are subject to structural changes, for example, there is a decrease in the number of functional glomeruli due to an increase in the prevalence of nephrosclerosis (atherosclerosis, glomerulosclerosis, atrophy of the tubules with interstitial fibrosis) and to some extent compensatory hypertrophy of the remaining nephrons. Older age is also associated with reduced cortical volume, increased medullary, and larger and more numerous renal cysts. Changes in normal aging are important in clinical practice. Against the background of suppression of reparative capabilities, the elderly are more prone to acute damage and chronic kidney disease, aggravation of the course of chronic kidney disease. The elderly have less renal functional reserve when they do actually develop chronic kidney disease and they are also at higher risk for acute kidney injury. Cardiovascular disease is a leading cause of death and a common comorbidity among patients with kidney disease. In this review, we have identified the most characteristic structural and functional changes in the kidneys in elderly patients and their impact on cardiovascular risk.

scholarly journals Kidney aging.Geriatric view

2021 ◽  
pp. 76-81
Author(s):  
L. I. Merkusheva ◽  
N. K. Runikhina ◽  
O. N. Tkacheva
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Structural Changes ◽  
Water Soluble ◽  
Older Age ◽  
Sodium Reabsorption ◽  
Tubular Atrophy ◽  
Age Related ◽  
Population Demographic

Individuals age >65 years old are the fastest expanding population demographic throughout the developed world. Consequently, more aged patients than before are receiving diagnoses of impaired renal function and nephrosclerosis. In this review, we examine these features of the aged kidney and explore the various validated and putative pathways contributing to the changes observed with aging. Senescence or normal physiologic aging portrays the expected age-related changes in the kidney as compared to chronic kidney disease (CKD) in some individuals. The microanatomical structural changes of the kidney with older age include a decreased number of functional glomeruli from an increased prevalence of nephrosclerosis (arteriosclerosis, glomerulosclerosis, and tubular atrophy with interstitialfibrosis), and to some extent, compensatory hypertrophy of remaining nephrons. Among the macroanatomical structural changes, older age associates with smaller cortical volume. There is reason to be concerned that the elderly are being misdiagnosed with CKD. In addition to the structural changes in the kidney associated with aging, physiological changes in renal function are also found in older adults, such as decreased glomerular filtration rate, vascular dysautonomia, altered tubular handling of creatinine, reduction in sodium reabsorption and potassium secretion, and diminished renal reserve. These alterations make aged individuals susceptible to the development of clinical conditions in response to usual stimuli that would otherwise be compensated for in younger individuals, including acute kidney injury, volume depletion and overload, disorders of serum sodium and potassium concentration, and toxic reactions to water -soluble drugs excreted by the kidneys. Additionally, the preservation with aging of a normal urinalysis, normal serum urea and creatinine values, erythropoietin synthesis, and normal phosphorus, calcium and magnesium tubular handling distinguishes decreased GFR due to normal aging from that due to chronic kidney disease.

scholarly journals MEDICATION BURDEN AND INAPPROPRIATE PRESCRIPTION RISK AMONG ELDERLY WITH ADVANCED CHRONIC KIDNEY DISEASE

2019 ◽  
Author(s):  
Clarisse Roux-Marson ◽  
Jean-Baptiste Baranski ◽  
Coraline Fafin ◽  
Guillaume Extermann ◽  
Cecile Vigneau ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Elderly Patients ◽  
Healthcare Providers ◽  
Antihypertensive Agents ◽  
The Elderly ◽  
Anticholinergic Drugs ◽  
Cross Sectional ◽  
French Study ◽  
Sectional Analysis

Abstract Background Elderly patients with chronic kidney disease (CKD) frequently present comorbidities that put them at risk of polypharmacy and medication-related problems. This study aims to describe the overall medication profile of patients aged ≥ 75 years with advanced CKD from a multicenter French study and specifically the renally (RIMs) and potentially inappropriate-for-the-elderly medications (PIMs) that they take. Methods This is a cross-sectional analysis of medication profiles of individuals aged ≥ 75 years with eGFR < 20 ml/min/1.73m2 followed by a nephrologist, who collected their active prescriptions at the study inclusion visit. Medication profiles were analyzed according to route of administration, therapeutic classification, and their potential inappropriateness for these patients, according to Beers' criteria. Results We collected 5196 individual medication prescriptions for 556 patients, for a median of 9 daily medications [7-11]. Antihypertensive agents, antithrombotics, and antianemics were the classes most frequently prescribed. Moreover, 88% of patients had at least 1 medication classified as a RIM, and 21% of those were contraindicated drugs. At least 1 PIM was taken by 68.9%. The prescriptions most frequently requiring reassessment due to potential adverse effects were for proton pump inhibitors and allopurinol. The PIMs for which deprescription is especially important in this population are rilmenidine, long-term benzodiazepines, and anticholinergic drugs such as hydroxyzine. Conclusion We showed potential drug-related problems in elderly patients with advanced CKD. Healthcare providers must reassess each medication prescribed for this population, particularly the specific medications identified here.

Dabigatran etexilate: appropriate use in patients with chronic kidney disease and in the elderly patients

2017 ◽  
Vol 12 (4) ◽  
pp. 425-435 ◽  
Author(s):  
Mauro Molteni ◽  
Mario Bo ◽  
Giovanni Di Minno ◽  
Giuseppe Di Pasquale ◽  
Simonetta Genovesi ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Elderly Patients ◽  
Dabigatran Etexilate ◽  
The Elderly ◽  
Appropriate Use

scholarly journals Pacemaker Therapy in the Elderly and Very Elderly

2021 ◽  
pp. 1-3
Author(s):  
Alexander Marschall ◽  
Alexander Marschall ◽  
Andrea Rueda Liñares ◽  
Belen Biscotti Rodil ◽  
Montserrat Torres Lopez ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Prognostic Factors ◽  
Kidney Disease ◽  
Elderly Patients ◽  
Cox Regression ◽  
The Elderly ◽  
Very Elderly ◽  
Pacemaker Therapy ◽  
All Cause Mortality

Background: The number of elderly patients undergoing pacemaker (PM) implantation is constantly growing. However, information on survival and prognostic factors of this particular patient group is scarce. The objective of this study was to determine the survival of elderly and very elderly patients undergoing PM implantation, as well as to investigate prognostic factors of mortality. Methods: This is a retrospective observational study of a single center. Patients ≥ 80 years of age, that underwent PM implantation between January 2017 and December 2018 in our center, were included for chart review. Very elderly patients were defined as those with ≥ 90 years of age. Results: A total of 269 patients were included in the study with a mean age of 85 (±4.1) years. 53 patients were ≥ 90 years of age. 52% of the patients were male. 24.5% of the elderly patients and 41.5% of the very elderly patients received a single chamber PM. Median follow-up time was 28 (14-30) months, with no significant differences between the two groups of patients. The mortality rate for elderly patients was 15.7% for the elderly and 32.1% for the very elderly (p = 0.002). Generating multivariate Cox regression models, the following parameters showed to be significant predictors of all-cause mortality: Age (1.37 (1.02-1.29), p = 0.005), chronic kidney disease (5.57 (2.47-12.56), p<0.001), COPD (3.74 (1.19-11.55), p = 0.023) and cancer (3.57 (1.02-12.51), p = 0.046). In the group of the very elderly only age (1.58 (1.10-2.27), p = 0.014) and cancer (3.76 (2.38-4.18), p = 0.003) significantly predicted mortality. Conclusion: Our study shows a good life expectancy of elderly and very elderly patients that underwent PM implantation, with a survival rate that is comparable to the general population. The primary prognostic factors were non-cardiological and comorbidities, such as chronic kidney disease, cancer and COPD, had a stronger association with mortality than age.

scholarly journals Pacemaker therapy in the elderly and very elderly: survival and prognostic factors

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
HA Del Castillo-Carnevali ◽  
A Marschall ◽  
M Torres-Lopez ◽  
E Basabe-Velasco ◽  
I Gomez-Sanchez ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Prognostic Factors ◽  
Kidney Disease ◽  
Elderly Patients ◽  
Cox Regression ◽  
The Elderly ◽  
Very Elderly ◽  
Pacemaker Therapy ◽  
Funding Sources

Abstract Funding Acknowledgements Type of funding sources: None. Background The number of elderly patients undergoing pacemaker (PM) implantation is constantly growing. However, information on survival and prognostic factors of this particular patient group is scarce. Objective The objective of this study was to determine the survival of elderly and very elderly patients undergoing PM implantation, as well as to investigate prognostic factors of mortality. Methods This is a retrospective observational study of a single centre. Patients ≥ 80 years of age, that underwent PM implantation between January 2017 and December 2018 in our centre, were included for chart review. Very elderly patients were defined as those with ≥ 90 years of age. Results A total of 269 patients were included in the study with a mean age of 85 (±4.1) years. 53 patients were ≥ 90 years of age. 52% of the patients were male. 24.5% of the elderly patients and 41.5% of the very elderly patients received a single chamber PM. Median follow-up time was 28 (14-30) months, with no significant differences between the two groups of patients. The mortality rate for elderly patients was 15.7% for the elderly and 32.1% for the very elderly (p = 0.002). Generating multivariate Cox regression models, the following parameters showed to be significant predictors of all-cause mortality: Age (1.37 (1.02-1.29), p = 0.005), chronic kidney disease (5.57 (2.47-12.56), p &lt; 0.001), COPD (3.74 (1.19-11.55), p = 0.023) and cancer (3.57 (1.02-12.51), p = 0.046). In the group of the very elderly only age (1.58 (1.10-2.27), p = 0.014) and cancer (3.76 (2.38-4.18), p = 0.003) significantly predicted mortality. Conclusions Our study shows a good life expectancy of elderly and very elderly patients, that underwent PM implantation, with a survival rate that is comparable to the general population. The primary prognostic factors were non-cardiological and co-morbidities, such as chronic kidney disease, cancer and COPD, had a stronger association with mortality than age.

scholarly journals Medication Burden And Inappropriate Prescription Risk Among Elderly With Advanced Chronic Kidney Disease

2019 ◽  
Author(s):  
Clarisse Roux-Marson ◽  
Jean-Baptiste Baranski ◽  
Coraline Fafin ◽  
Guillaume Extermann ◽  
Cecile Vigneau ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Elderly Patients ◽  
Healthcare Providers ◽  
Antihypertensive Agents ◽  
The Elderly ◽  
Anticholinergic Drugs ◽  
Cross Sectional ◽  
Dose Modification ◽  
Severe Impairment

Abstract Background Elderly patients with chronic kidney disease (CKD) frequently present comorbidities that put them at risk of polypharmacy and medication-related problems. This study aims to describe the overall medication profile of patients aged ≥ 75 years with advanced CKD from a multicenter French study and specifically the renally (RIMs) and potentially inappropriate-for-the-elderly medications (PIMs) that they take. Methods This is a cross-sectional analysis of medication profiles of individuals aged ≥ 75 years with eGFR < 20 ml/min/1.73m2 followed by a nephrologist, who collected their active prescriptions at the study inclusion visit. Medication profiles were first analyzed according to route of administration, therapeutic classification. Second, patients were classified according to their risk of potential medication-related problems, based on whether the prescription was a RIM or a PIM. RIMs and PIMs have been defined according to renal appropriateness guidelines and to Beer’s criteria in the elderly. RIMs were subclassified by 4 types of category : (a) contraindication; (b) dose modification is recommended based on creatinine clearance (CrCl); (c) dose modification based on CrCl is not recommended but a maximum daily dose is mentioned, (d) no specific recommendations based on CrCl : “use with caution”, “avoid in severe impairment”, “careful monitoring of dose is required” “reduce the dose”. Results We collected 5196 individual medication prescriptions for 556 patients, for a median of 9 daily medications [7-11]. Antihypertensive agents, antithrombotics, and antianemics were the classes most frequently prescribed. Moreover, 77.0% of patients had at least 1 medication classified as a RIM. They accounted 31.3% of the drugs prescribed and 9.25% was contraindicated drugs. At least 1 PIM was taken by 57.6% and 45.5% of patients had at least one medication classified as RIM and PIM. The prescriptions most frequently requiring reassessment due to potential adverse effects were for proton pump inhibitors and allopurinol. The PIMs for which deprescription is especially important in this population are rilmenidine, long-term benzodiazepines, and anticholinergic drugs such as hydroxyzine. Conclusion We showed potential drug-related problems in elderly patients with advanced CKD. Healthcare providers must reassess each medication prescribed for this population, particularly the specific medications identified here.

Markers of increased cardiovascular risk in elderly patients with chronic kidney disease: A preliminary study

2015 ◽  
Vol 241 (1) ◽  
pp. e184
Author(s):  
A. Gluba-Brzózka ◽  
M. Michalska-Kasiczak ◽  
B. Franczyk-Skóra ◽  
M. Nocun ◽  
M. Banach ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Cardiovascular Risk ◽  
Kidney Disease ◽  
Elderly Patients ◽  
Preliminary Study

scholarly journals The Benefit of Anti-Inflammatory and Renal-Protective Dietary Ingredients on the Biological Processes of Aging in the Kidney

Biology ◽  
2018 ◽  
Vol 7 (4) ◽  
pp. 45 ◽  
Author(s):  
Kiran Panickar ◽  
Dennis Jewell
Keyword(s):  
Oxidative Stress ◽  
Renal Function ◽  
Kidney Function ◽  
Structural Changes ◽  
Dietary Intervention ◽  
Interstitial Fibrosis ◽  
Tubular Atrophy ◽  
Functional Changes ◽  
General Decline ◽  
Organ Systems

One of the significant organ systems which decline in aging is the kidney. While the causes of age-associated decline in renal function are likely multifactorial, oxidative stress and inflammation are hypothesized to play important roles in the structural and functional changes of the kidney. During aging there is a general decline in the glomerular filtration rate (GFR), a primary measurement used to assess kidney function. Inflammation and oxidative stress have been hypothesized to have a significant detrimental effect on renal function in aging and this may be attenuated by renal protective dietary ingredients. These dietary ingredients may affect renal function directly or through a microbiome-mediated secondary product. Likewise, structural changes including renal tubular atrophy, interstitial fibrosis, and glomerulosclerosis have all been described in aging. Such detrimental changes may benefit from dietary ingredients that may delay or attenuate the occurrence of such changes. This review will describe the physiology and pathophysiology of aging in renal function with an emphasis on dogs and cats that develop a decline in kidney function naturally. In addition, the varying biomarkers of health and renal dysfunction will be discussed. Finally, we will evaluate the aid in the management of this normal decline through dietary intervention in animal models.

scholarly journals Urinary C-type natriuretic peptide excretion: a potential novel biomarker for renal fibrosis during aging

2011 ◽  
Vol 301 (5) ◽  
pp. F943-F952 ◽  
Author(s):  
S. Jeson Sangaralingham ◽  
Denise M. Heublein ◽  
Joseph P. Grande ◽  
Alessandro Cataliotti ◽  
Andrew D. Rule ◽  
...  
Keyword(s):  
Natriuretic Peptide ◽  
Renal Fibrosis ◽  
Structural Changes ◽  
Microscopic Analysis ◽  
The Elderly ◽  
Electron Microscopic ◽  
Functional Changes ◽  
Age Related ◽  
Increased Risk ◽  
Renal Aging

Renal aging is characterized by structural changes in the kidney including fibrosis, which contributes to the increased risk of kidney and cardiac failure in the elderly. Studies involving healthy kidney donors demonstrated subclinical age-related nephropathy on renal biopsy that was not detected by standard diagnostic tests. Thus there is a high-priority need for novel noninvasive biomarkers to detect the presence of preclinical age-associated renal structural and functional changes. C-type natriuretic peptide (CNP) possesses renoprotective properties and is present in the kidney; however, its modulation during aging remains undefined. We assessed circulating and urinary CNP in a Fischer rat model of experimental aging and also determined renal structural and functional adaptations to the aging process. Histological and electron microscopic analysis demonstrated significant renal fibrosis, glomerular basement membrane thickening, and mesangial matrix expansion with aging. While plasma CNP levels progressively declined with aging, urinary CNP excretion increased, along with the ratio of urinary to plasma CNP, which preceded significant elevations in proteinuria and blood pressure. Also, CNP immunoreactivity was increased in the distal and proximal tubules in both the aging rat and aging human kidneys. Our findings provide evidence that urinary CNP and its ratio to plasma CNP may represent a novel biomarker for early age-mediated renal structural alterations, particularly fibrosis. Thus urinary CNP could potentially aid in identifying subjects with preclinical structural changes before the onset of symptoms and disease, allowing for the initiation of strategies designed to prevent the progression of chronic kidney disease particularly in the aging population.

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