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Care of elderly patients with chronic kidney disease

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Abstract

Background

Providing optimal care to the growing number of chronic kidney disease (CKD) patients remains a significant problem in the United States. There is little known about the care of elderly CKD patients by primary care physicians as well as nephrologists.

Methods

We performed a retrospective study of 377 elderly male CKD (serum creatinine >1.4 mg/dl on 2 separate occasions 3 months apart) patients referred to the Nephrology Clinic at the Buffalo Veterans Administration Medical Center between 1999 and 2002 to see if the pattern of care changed during this time.

Results

The mean age of the patients was 75.9 years. Eighty-four percent were Caucasian, 15% were African-American, and 1% were of other race. Etiology of CKD included hypertensive nephrosclerosis (49%), diabetic nephropathy (23%), renovascular disease (18%), and others (10%). Sixty-five percent of patients had estimated glomerular filtration rate (eGFR) >30 ml/min. Overall angiotensin converting enzyme inhibitor (ACEI) was used in 51% of patients with CKD, and in 63% of patients with diabetic nephropathy. Twenty percent of patients had a hemoglobin <11 g/dl, darbepoietin/epogen was used in 31% of these patients. Screening for kidney related tests were done infrequently while lipid profile and hemoglobin A1C were done in the majority of patients because of clinical reminders in the VA computerized patient record system (CPRS).

Conclusion

These results emphasize the need for increased education of primary care physicians and nephrologists to improve the care of elderly CKD patients. Although there was a trend towards earlier referral, care did not change significantly between years 1999 and 2002.

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Authors and Affiliations

  1. Division of Nephrology, VAMC, State University of NY at Buffalo, Buffalo, NY, 14215, USA

    Pradeep Arora & James Lohr

  2. Departments of Medicine, State University of NY at Buffalo, Buffalo, NY, USA

    Pradeep Arora, Reem A. Mustafa, Jyotheen Karam, Patricia Khalil, Rajiv Ranjan & James Lohr

  3. Departments of Biostatistics, State University of NY at Buffalo, Buffalo, NY, USA

    Greg Wilding

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  1. Pradeep Arora
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  2. Reem A. Mustafa
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  3. Jyotheen Karam
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  4. Patricia Khalil
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  7. James Lohr
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Correspondence to Pradeep Arora.

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Arora, P., Mustafa, R.A., Karam, J. et al. Care of elderly patients with chronic kidney disease. Int Urol Nephrol 38, 363–370 (2006). https://doi.org/10.1007/s11255-006-0046-x

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