Aging and Chronic Kidney Disease

  • Tao ZhangEmail author


With renal aging, a complex interplay of genetics, environmental changes, and cellular dysfunction leads to the histological and functional changes. The faster expanding population of elderly is more likely to experience chronic kidney disease (CKD) and progress to end-stage kidney disease (ESRD). Glomerular filtration rate (GFR) is the most important indicator commonly used for the diagnosis and grading of CKD. The MDRD and CG formulas are the most widely applied, and the CKD-EPISCr–cys formula is an acceptable choice for the elderly. The treatment of CKD in older patients requires overall consideration because the risk of cardiovascular disease mortality is greater than the risk of developing ESRD at the same GFR level. An individualized patient-centered approach may offer more benefits than a traditional disease-oriented approach in old patients. There are few clinical practice guidelines on the management of the elderly with CKD. The European guideline recommends the use of four variables (age, sex, eGFR, and albuminuria) to predict the risk of ESRD and of the REIN score to predict the risk of mortality in older patients with stage 5 CKD. Further studies are required for solving the controversy concerning CKD in the elderly.


  1. 1.
    Blum-Lehmann S. Fragility and experiencing limits as a chance for development in old age—the meaning of the particular experiences of the aging body for identification and development as focused on the very old. Z Gerontol Geriatr. 2008;41(3):201–7.PubMedCrossRefGoogle Scholar
  2. 2.
    Hommos MS, Glassock RJ, Rule AD. Structural and functional changes in human kidneys with healthy aging. J Am Soc Nephrol. 2017;28(10):2838–44.PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    Knickman JR, Snell EK. The 2030 problem: caring for aging baby boomers. Health Serv Res. 2002;37(4):849–84.PubMedPubMedCentralCrossRefGoogle Scholar
  4. 4.
    Campbell KH, O’Hare AM. Kidney disease in the elderly: update on recent literature. Curr Opin Nephrol Hypertens. 2008;17(3):298–303.PubMedCrossRefGoogle Scholar
  5. 5.
    Porter CJ, Moppett IK, Juurlink I, Nightingale J, Moran CG, Devonald MA. Acute and chronic kidney disease in elderly patients with hip fracture: prevalence, risk factors and outcome with development and validation of a risk prediction model for acute kidney injury. BMC Nephrol. 2017;18(1):20.PubMedPubMedCentralCrossRefGoogle Scholar
  6. 6.
    Chuang MH, Liao KM, Hung YM, Chou YC, Chou P. Association of TSH elevation with all-cause mortality in elderly patients with chronic kidney disease. PLoS One. 2017;12(1):e0168611.PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Sumida K, Molnar MZ, Potukuchi PK, et al. Association of slopes of estimated glomerular filtration rate with post-end-stage renal disease mortality in patients with advanced chronic kidney disease transitioning to dialysis. Mayo Clin Proc. 2016;91(2):196–207.PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Tonelli M, Riella MC. World Kidney Day 2014: CKD and the aging population. Am J Kidney Dis. 2014;63(3):349–53.PubMedCrossRefGoogle Scholar
  9. 9.
    Coresh J, Selvin E, Stevens LA, et al. Prevalence of chronic kidney disease in the United States. JAMA. 2007;298(17):2038–47.PubMedCrossRefGoogle Scholar
  10. 10.
    Murphy D, McCulloch CE, Lin F, et al. Trends in prevalence of chronic kidney disease in the United States. Ann Intern Med. 2016;165(7):473–81.PubMedPubMedCentralCrossRefGoogle Scholar
  11. 11.
    Saran R, Li Y, Robinson B, et al. US Renal Data System 2015 Annual Data Report: epidemiology of kidney disease in the United States. Am J Kidney Dis. 2016;67(3 Suppl 1):S1–305.Google Scholar
  12. 12.
    Wang S, Chen R, Liu Q, Shu Z, Zhan S, Li L. Prevalence, awareness and treatment of chronic kidney disease among middle-aged and elderly: the China health and retirement longitudinal study. Nephrology (Carlton). 2015;20(7):474–84.CrossRefGoogle Scholar
  13. 13.
    Glassock RJ, Rule AD. Aging and the kidneys: anatomy, physiology and consequences for defining chronic kidney disease. Nephron. 2016;134(1):25–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Lindeman RD, Tobin J, Shock NW. Longitudinal studies on the rate of decline in renal function with age. J Am Geriatr Soc. 1985;33(4):278–85.PubMedCrossRefGoogle Scholar
  15. 15.
    Inker LA, Astor BC, Fox CH, et al. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for the evaluation and management of CKD. Am J Kidney Dis. 2014;63(5):713–35.PubMedPubMedCentralCrossRefGoogle Scholar
  16. 16.
    Andrassy KM. Comments on ‘KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease’. Kidney Int. 2013;84(3):622–3.PubMedCrossRefGoogle Scholar
  17. 17.
    Moynihan R, Glassock R, Doust J. Chronic kidney disease controversy: how expanding definitions are unnecessarily labelling many people as diseased. BMJ. 2013;347:f4298.PubMedCrossRefGoogle Scholar
  18. 18.
    Glassock R, Delanaye P, El NM. An age-calibrated classification of chronic kidney disease. JAMA. 2015;314(6):559–60.PubMedCrossRefGoogle Scholar
  19. 19.
    Tangri N, Grams ME, Levey AS, et al. Multinational assessment of accuracy of equations for predicting risk of kidney failure: a meta-analysis. JAMA. 2016;315(2):164–74.PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    Hallan SI, Matsushita K, Sang Y, et al. Age and association of kidney measures with mortality and end-stage renal disease. JAMA. 2012;308(22):2349–60.PubMedPubMedCentralCrossRefGoogle Scholar
  21. 21.
    Dousdampanis P, Trigka K, Fourtounas C. Diagnosis and management of chronic kidney disease in the elderly: a field of ongoing debate. Aging Dis. 2012;3(5):360–72.PubMedPubMedCentralGoogle Scholar
  22. 22.
    Gansevoort RT, Correa-Rotter R, Hemmelgarn BR, et al. Chronic kidney disease and cardiovascular risk: epidemiology, mechanisms, and prevention. Lancet. 2013;382(9889):339–52.PubMedCrossRefGoogle Scholar
  23. 23.
    Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of diet in renal disease study group. Ann Intern Med. 1999;130(6):461–70.CrossRefPubMedGoogle Scholar
  24. 24.
    Yonezawa Y, Horinaka S, Shirakawa C, Kogure Y. Estimated glomerular filtration ratio is a better index than creatinine clearance (Cockcroft-Gault) for predicting the prevalence of atrial fibrillation in the general Japanese population. Hypertens Res. 2018;41:451.PubMedCrossRefGoogle Scholar
  25. 25.
    Levey AS, Stevens LA. Estimating GFR using the CKD epidemiology collaboration (CKD-EPI) creatinine equation: more accurate GFR estimates, lower CKD prevalence estimates, and better risk predictions. Am J Kidney Dis. 2010;55(4):622–7.PubMedPubMedCentralCrossRefGoogle Scholar
  26. 26.
    Matsushita K, Mahmoodi BK, Woodward M, et al. Comparison of risk prediction using the CKD-EPI equation and the MDRD study equation for estimated glomerular filtration rate. JAMA. 2012;307(18):1941–51.PubMedCrossRefGoogle Scholar
  27. 27.
    Stevens LA, Schmid CH, Greene T, et al. Comparative performance of the CKD epidemiology collaboration (CKD-EPI) and the modification of diet in renal disease (MDRD) study equations for estimating GFR levels above 60 mL/min/1.73 m2. Am J Kidney Dis. 2010;56(3):486–95.PubMedPubMedCentralCrossRefGoogle Scholar
  28. 28.
    Matsushita K, Tonelli M, Lloyd A, Levey AS, Coresh J, Hemmelgarn BR. Clinical risk implications of the CKD epidemiology collaboration (CKD-EPI) equation compared with the modification of diet in renal disease (MDRD) study equation for estimated GFR. Am J Kidney Dis. 2012;60(2):241–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Grubb A, Björk J, Nyman U, et al. Cystatin C, a marker for successful aging and glomerular filtration rate, is not influenced by inflammation. Scand J Clin Lab Invest. 2011;71(2):145–9.PubMedPubMedCentralCrossRefGoogle Scholar
  30. 30.
    Roos JF, Doust J, Tett SE, Kirkpatrick CM. Diagnostic accuracy of cystatin C compared to serum creatinine for the estimation of renal dysfunction in adults and children—a meta-analysis. Clin Biochem. 2007;40(5–6):383–91.PubMedCrossRefGoogle Scholar
  31. 31.
    Song S, Meyer M, Türk TR, et al. Serum cystatin C in mouse models: a reliable and precise marker for renal function and superior to serum creatinine. Nephrol Dial Transplant. 2009;24(4):1157–61.PubMedCrossRefPubMedCentralGoogle Scholar
  32. 32.
    Drenth-van MAC, Jansen PA, Proost JH, et al. Renal function assessment in older adults. Br J Clin Pharmacol. 2013;76(4):616–23.Google Scholar
  33. 33.
    Péquignot R, Belmin J, Chauvelier S, et al. Renal function in older hospital patients is more accurately estimated using the Cockcroft-Gault formula than the modification diet in renal disease formula. J Am Geriatr Soc. 2009;57(9):1638–43.PubMedCrossRefPubMedCentralGoogle Scholar
  34. 34.
    Helou R. Should we continue to use the Cockcroft-Gault formula. Nephron Clin Pract. 2010;116(3):c172–85; discussion c186.PubMedCrossRefGoogle Scholar
  35. 35.
    Flamant M, Haymann JP, Vidal-Petiot E, et al. GFR estimation using the Cockcroft-Gault, MDRD study, and CKD-EPI equations in the elderly. Am J Kidney Dis. 2012;60(5):847–9.PubMedCrossRefPubMedCentralGoogle Scholar
  36. 36.
    Nyman U, Grubb A, Sterner G, Björk J. The CKD-EPI and MDRD equations to estimate GFR. Validation in the Swedish Lund-Malmö study cohort. Scand J Clin Lab Invest. 2011;71(2):129–38.PubMedCrossRefGoogle Scholar
  37. 37.
    Dowling TC, Wang ES, Ferrucci L, Sorkin JD. Glomerular filtration rate equations overestimate creatinine clearance in older individuals enrolled in the Baltimore longitudinal study on aging: impact on renal drug dosing. Pharmacotherapy. 2013;33(9):912–21.PubMedPubMedCentralCrossRefGoogle Scholar
  38. 38.
    Fontseré N, Bonal J, Navarro M, et al. A comparison of prediction equations for estimating glomerular filtration rate in adult patients with chronic kidney disease stages 4-5. Effect of nutritional status and age. Nephron Clin Pract. 2006;104(4):c160–8.PubMedCrossRefGoogle Scholar
  39. 39.
    Kilbride HS, Stevens PE, Eaglestone G, et al. Accuracy of the MDRD (modification of diet in renal disease) study and CKD-EPI (CKD epidemiology collaboration) equations for estimation of GFR in the elderly. Am J Kidney Dis. 2013;61(1):57–66.PubMedCrossRefPubMedCentralGoogle Scholar
  40. 40.
    Koppe L, Klich A, Dubourg L, Ecochard R, Hadj-Aissa A. Performance of creatinine-based equations compared in older patients. J Nephrol. 2013;26(4):716–23.PubMedCrossRefGoogle Scholar
  41. 41.
    Levin A, Stevens PE. Summary of KDIGO 2012 CKD guideline: behind the scenes, need for guidance, and a framework for moving forward. Kidney Int. 2014;85(1):49–61.PubMedCrossRefGoogle Scholar
  42. 42.
    Farrington K, Covic A, Aucella F, et al. Clinical Practice Guideline on management of older patients with chronic kidney disease stage 3b or higher (eGFR <45 mL/min/1.73 m2). Nephrol Dial Transplant. 2016;31(suppl 2):ii1–ii66.PubMedCrossRefGoogle Scholar
  43. 43.
    Farrington K, Covic A, Nistor I, et al. Clinical practice guideline on management of older patients with chronic kidney disease stage 3b or higher (eGFR<45 mL/min/1.73 m2): a summary document from the European Renal Best Practice Group. Nephrol Dial Transplant. 2017;32(1):9–16.PubMedCrossRefGoogle Scholar
  44. 44.
    Ceretta ML, Noordzij M, Luxardo R, et al. Changes in co-morbidity pattern in patients starting renal replacement therapy in Europe-data from the ERA-EDTA Registry. Nephrol Dial Transplant. 2018;33(10):1794–804.PubMedCrossRefGoogle Scholar
  45. 45.
    Pippias M, Jager KJ, Kramer A, et al. The changing trends and outcomes in renal replacement therapy: data from the ERA-EDTA registry. Nephrol Dial Transplant. 2016;31(5):831–41.PubMedCrossRefGoogle Scholar
  46. 46.
    Van Biesen W, van der Veer SN, Jager KJ, Fouque D, Wanner C, Vanholder R. What guidelines should or should not be: implications for guideline production. Nephrol Dial Transplant. 2013;28(8):1980–4.PubMedCrossRefGoogle Scholar
  47. 47.
    van der Veer SN, Tomson CR, Jager KJ, van Biesen W. Bridging the gap between what is known and what we do in renal medicine: improving implementability of the European renal best practice guidelines. Nephrol Dial Transplant. 2014;29(5):951–7.PubMedCrossRefGoogle Scholar
  48. 48.
    Bowling CB, Sharma P, Muntner P. Prevalence, trends and functional impairment associated with reduced estimated glomerular filtration rate and albuminuria among the oldest-old U.S. adults. Am J Med Sci. 2014;348(2):115–20.PubMedPubMedCentralCrossRefGoogle Scholar
  49. 49.
    van de Luijtgaarden MW, Noordzij M, van Biesen W, et al. Conservative care in Europe—nephrologists’ experience with the decision not to start renal replacement therapy. Nephrol Dial Transplant. 2013;28(10):2604–12.PubMedCrossRefPubMedCentralGoogle Scholar
  50. 50.
    Tripepi G, Heinze G, Jager KJ, Stel VS, Dekker FW, Zoccali C. Risk prediction models. Nephrol Dial Transplant. 2013;28(8):1975–80.PubMedCrossRefGoogle Scholar
  51. 51.
    Noordzij M, van Diepen M, Caskey FC, Jager KJ. Relative risk versus absolute risk: one cannot be interpreted without the other. Nephrol Dial Transplant. 2017;32(suppl_2):ii13–8.PubMedCrossRefGoogle Scholar
  52. 52.
    Vogelzang JL, van Stralen KJ, Jager KJ, Groothoff JW. Trend from cardiovascular to non-cardiovascular late mortality in patients with renal replacement therapy since childhood. Nephrol Dial Transplant. 2013;28(8):2082–9.PubMedCrossRefGoogle Scholar
  53. 53.
    Stengel B, Billon S, Van Dijk PC, et al. Trends in the incidence of renal replacement therapy for end-stage renal disease in Europe, 1990-1999. Nephrol Dial Transplant. 2003;18(9):1824–33.PubMedCrossRefGoogle Scholar
  54. 54.
    Murtagh FE, Murphy E, Sheerin NS. Illness trajectories: an important concept in the management of kidney failure. Nephrol Dial Transplant. 2008;23(12):3746–8.PubMedCrossRefGoogle Scholar
  55. 55.
    Kurella M, Covinsky KE, Collins AJ, Chertow GM. Octogenarians and nonagenarians starting dialysis in the United States. Ann Intern Med. 2007;146(3):177–83.PubMedCrossRefGoogle Scholar
  56. 56.
    Bloembergen WE, Port FK, Mauger EA, Wolfe RA. A comparison of mortality between patients treated with hemodialysis and peritoneal dialysis. J Am Soc Nephrol. 1995;6(2):177–83.PubMedGoogle Scholar
  57. 57.
    Winkelmayer WC, Glynn RJ, Mittleman MA, Levin R, Pliskin JS, Avorn J. Comparing mortality of elderly patients on hemodialysis versus peritoneal dialysis: a propensity score approach. J Am Soc Nephrol. 2002;13(9):2353–62.CrossRefGoogle Scholar
  58. 58.
    Matas AJ, Smith JM, Skeans MA, et al. OPTN/SRTR 2011 annual data report: kidney. Am J Transplant. 2013;13(Suppl 1):11–46.PubMedCrossRefGoogle Scholar
  59. 59.
    Levey AS, Stevens LA, Coresh J. Conceptual model of CKD: applications and implications. Am J Kidney Dis. 2009;53(3 Suppl 3):S4–16.PubMedCrossRefGoogle Scholar
  60. 60.
    Tinetti ME, Fried T. The end of the disease era. Am J Med. 2004;116(3):179–85.PubMedCrossRefGoogle Scholar
  61. 61.
    Uhlig K, Boyd C. Guidelines for the older adult with CKD. Am J Kidney Dis. 2011;58(2):162–5.PubMedCrossRefGoogle Scholar
  62. 62.
    Goodwin JS. Geriatrics and the limits of modern medicine. N Engl J Med. 1999;340(16):1283–5.PubMedCrossRefGoogle Scholar
  63. 63.
    Locatelli F, Pisoni RL, Akizawa T, et al. Anemia management for hemodialysis patients: kidney disease outcomes quality initiative (K/DOQI) guidelines and Dialysis outcomes and practice patterns study (DOPPS) findings. Am J Kidney Dis. 2004;44(5 Suppl 2):27–33.PubMedCrossRefGoogle Scholar
  64. 64.
    National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39(2 Suppl 1):S1–266.Google Scholar
  65. 65.
    Tinetti ME, Studenski SA. Comparative effectiveness research and patients with multiple chronic conditions. N Engl J Med. 2011;364(26):2478–81.PubMedCrossRefGoogle Scholar
  66. 66.
    Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351(13):1296–305.CrossRefGoogle Scholar
  67. 67.
    Tangri N, Stevens LA, Griffith J, et al. A predictive model for progression of chronic kidney disease to kidney failure. JAMA. 2011;305(15):1553–9.PubMedCrossRefGoogle Scholar
  68. 68.
    Johnson ES, Thorp ML, Platt RW, Smith DH. Predicting the risk of dialysis and transplant among patients with CKD: a retrospective cohort study. Am J Kidney Dis. 2008;52(4):653–60.PubMedCrossRefGoogle Scholar
  69. 69.
    Peeters MJ, van Zuilen AD, van den Brand JA, Bots ML, Blankestijn PJ, Wetzels JF. Validation of the kidney failure risk equation in European CKD patients. Nephrol Dial Transplant. 2013;28(7):1773–9.PubMedCrossRefGoogle Scholar
  70. 70.
    Bansal N, Katz R, De Boer IH, et al. Development and validation of a model to predict 5-year risk of death without ESRD among older adults with CKD. Clin J Am Soc Nephrol. 2015;10(3):363–71.PubMedPubMedCentralCrossRefGoogle Scholar
  71. 71.
    McAdams-DeMarco MA, Law A, Salter ML, et al. Frailty as a novel predictor of mortality and hospitalization in individuals of all ages undergoing hemodialysis. J Am Geriatr Soc. 2013;61(6):896–901.PubMedPubMedCentralCrossRefGoogle Scholar
  72. 72.
    Fried LP, Borhani NO, Enright P, et al. The Cardiovascular Health Study: design and rationale. Ann Epidemiol. 1991;1(3):263–76.PubMedCrossRefGoogle Scholar
  73. 73.
    Rockwood K, Song X, MacKnight C, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173(5):489–95.PubMedPubMedCentralCrossRefGoogle Scholar
  74. 74.
    Lee SJ, Lindquist K, Segal MR, Covinsky KE. Development and validation of a prognostic index for 4-year mortality in older adults. JAMA. 2006;295(7):801–8.PubMedCrossRefGoogle Scholar
  75. 75.
    Couchoud C, Labeeuw M, Moranne O, et al. A clinical score to predict 6-month prognosis in elderly patients starting dialysis for end-stage renal disease. Nephrol Dial Transplant. 2009;24(5):1553–61.PubMedCrossRefGoogle Scholar
  76. 76.
    Couchoud CG, Beuscart JB, Aldigier JC, Brunet PJ, Moranne OP. Development of a risk stratification algorithm to improve patient-centered care and decision making for incident elderly patients with end-stage renal disease. Kidney Int. 2015;88(5):1178–86.PubMedCrossRefGoogle Scholar
  77. 77.
    Cheung KL, Montez-Rath ME, Chertow GM, Winkelmayer WC, Periyakoil VS, Kurella TM. Prognostic stratification in older adults commencing dialysis. J Gerontol A Biol Sci Med Sci. 2014;69(8):1033–9.PubMedPubMedCentralCrossRefGoogle Scholar
  78. 78.
    Painter P, Marcus RL. Assessing physical function and physical activity in patients with CKD. Clin J Am Soc Nephrol. 2013;8(5):861–72.PubMedCrossRefGoogle Scholar
  79. 79.
    Dalrymple LS, Katz R, Rifkin DE, et al. Kidney function and prevalent and incident frailty. Clin J Am Soc Nephrol. 2013;8(12):2091–9.PubMedPubMedCentralCrossRefGoogle Scholar
  80. 80.
    Roshanravan B, Khatri M, Robinson-Cohen C, et al. A prospective study of frailty in nephrology-referred patients with CKD. Am J Kidney Dis. 2012;60(6):912–21.PubMedPubMedCentralCrossRefGoogle Scholar
  81. 81.
    Painter P, Roshanravan B. The association of physical activity and physical function with clinical outcomes in adults with chronic kidney disease. Curr Opin Nephrol Hypertens. 2013;22(6):615–23.PubMedCrossRefGoogle Scholar
  82. 82.
    Saito GK, Jassal SV. The ‘Sit-to-Scale’ score—a pilot study to develop an easily applied score to follow functional status in elderly dialysis patients. Nephrol Dial Transplant. 2007;22(11):3318–21.PubMedCrossRefGoogle Scholar
  83. 83.
    Segura-Ortí E, Martínez-Olmos FJ. Test-retest reliability and minimal detectable change scores for sit-to-stand-to-sit tests, the six-minute walk test, the one-leg heel-rise test, and handgrip strength in people undergoing hemodialysis. Phys Ther. 2011;91(8):1244–52.PubMedCrossRefGoogle Scholar
  84. 84.
    Kutsuna T, Matsunaga A, Takagi Y, et al. Development of a novel questionnaire evaluating disability in activities of daily living in the upper extremities of patients undergoing maintenance hemodialysis. Ther Apher Dial. 2011;15(2):185–94.PubMedCrossRefGoogle Scholar
  85. 85.
    Anding K, Bär T, Trojniak-Hennig J, et al. A structured exercise programme during haemodialysis for patients with chronic kidney disease: clinical benefit and long-term adherence. BMJ Open. 2015;5(8):e008709.PubMedPubMedCentralCrossRefGoogle Scholar
  86. 86.
    Heiwe S, Jacobson SH. Exercise training for adults with chronic kidney disease. Cochrane Database Syst Rev. 2011;(10):CD003236.Google Scholar
  87. 87.
    Chen JL, Godfrey S, Ng TT, et al. Effect of intra-dialytic, low-intensity strength training on functional capacity in adult haemodialysis patients: a randomized pilot trial. Nephrol Dial Transplant. 2010;25(6):1936–43.PubMedPubMedCentralCrossRefGoogle Scholar
  88. 88.
    Esteve SV, Junqué JA, Moreno GF, et al. Benefits of a low intensity exercise programme during haemodialysis sessions in elderly patients. Nefrologia. 2015;35(4):385–94.CrossRefGoogle Scholar
  89. 89.
    Esteve SV, Junqué A, Fulquet M, et al. Complete low-intensity endurance training programme in haemodialysis patients: improving the care of renal patients. Nephron Clin Pract. 2014;128(3–4):387–93.CrossRefGoogle Scholar
  90. 90.
    Johansson L, Fouque D, Bellizzi V, et al. As we grow old: nutritional considerations for older patients on dialysis. Nephrol Dial Transplant. 2017;32(7):1127–36.PubMedGoogle Scholar
  91. 91.
    Ikizler TA, Cano NJ, Franch H, et al. Prevention and treatment of protein energy wasting in chronic kidney disease patients: a consensus statement by the International Society of Renal Nutrition and Metabolism. Kidney Int. 2013;84(6):1096–107.CrossRefGoogle Scholar
  92. 92.
    Szeto CC, Kwan BC, Chow KM, Law MC, Li PK. Geriatric nutritional risk index as a screening tool for malnutrition in patients on chronic peritoneal dialysis. J Ren Nutr. 2010;20(1):29–37.PubMedCrossRefGoogle Scholar
  93. 93.
    Piratelli CM, Telarolli JR. Nutritional evaluation of stage 5 chronic kidney disease patients on dialysis. Sao Paulo Med J. 2012;130(6):392–7.PubMedCrossRefGoogle Scholar
  94. 94.
    Smith C, Da SM, Chandna S, Warwicker P, Greenwood R, Farrington K. Choosing not to dialyse: evaluation of planned non-dialytic management in a cohort of patients with end-stage renal failure. Nephron Clin Pract. 2003;95(2):c40–6.PubMedCrossRefGoogle Scholar
  95. 95.
    Verberne WR, Geers AB, Jellema WT, Vincent HH, van Delden JJ, Bos WJ. Comparative survival among older adults with advanced kidney disease managed conservatively versus with dialysis. Clin J Am Soc Nephrol. 2016;11(4):633–40.PubMedPubMedCentralCrossRefGoogle Scholar
  96. 96.
    Shum CK, Tam KF, Chak WL, Chan TC, Mak YF, Chau KF. Outcomes in older adults with stage 5 chronic kidney disease: comparison of peritoneal dialysis and conservative management. J Gerontol A Biol Sci Med Sci. 2014;69(3):308–14.PubMedCrossRefGoogle Scholar
  97. 97.
    Rodriguez VI, Ortega O, Hinostroza J, et al. Geriatric assessment for therapeutic decision-making regarding renal replacement in elderly patients with advanced chronic kidney disease. Nephron Clin Pract. 2014;128(1–2):73–8.CrossRefGoogle Scholar
  98. 98.
    Carson RC, Juszczak M, Davenport A, Burns A. Is maximum conservative management an equivalent treatment option to dialysis for elderly patients with significant comorbid disease. Clin J Am Soc Nephrol. 2009;4(10):1611–9.PubMedPubMedCentralCrossRefGoogle Scholar
  99. 99.
    Hussain JA, Mooney A, Russon L. Comparison of survival analysis and palliative care involvement in patients aged over 70 years choosing conservative management or renal replacement therapy in advanced chronic kidney disease. Palliat Med. 2013;27(9):829–39.PubMedCrossRefGoogle Scholar
  100. 100.
    Peeters P, Van Biesen W, Veys N, Lemahieu W, De Moor B, De Meester J. External validation of a risk stratification model to assist shared decision making for patients starting renal replacement therapy. BMC Nephrol. 2016;17:41.PubMedPubMedCentralCrossRefGoogle Scholar
  101. 101.
    O'Connor NR, Kumar P. Conservative management of end-stage renal disease without dialysis: a systematic review. J Palliat Med. 2012;15(2):228–35.PubMedPubMedCentralCrossRefGoogle Scholar
  102. 102.
    Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924–6.PubMedPubMedCentralCrossRefGoogle Scholar
  103. 103.
    Da SM, Wellsted D, Greenshields H, Norton S, Chandna SM, Farrington K. Quality of life and survival in patients with advanced kidney failure managed conservatively or by dialysis. Clin J Am Soc Nephrol. 2012;7(12):2002–9.CrossRefGoogle Scholar
  104. 104.
    Abecassis M, Bridges ND, Clancy CJ, et al. Solid-organ transplantation in older adults: current status and future research. Am J Transplant. 2012;12(10):2608–22.PubMedPubMedCentralCrossRefGoogle Scholar
  105. 105.
    De La Vega LS, Torres A, Bohorquez HE, et al. Patient and graft outcomes from older living kidney donors are similar to those from younger donors despite lower GFR. Kidney Int. 2004;66(4):1654–61.CrossRefGoogle Scholar
  106. 106.
    Rebollo P, Ortega F, Baltar JM, Alvarez-Ude F, Alvarez NR, Alvarez-Grande J. Is the loss of health-related quality of life during renal replacement therapy lower in elderly patients than in younger patients. Nephrol Dial Transplant. 2001;16(8):1675–80.PubMedCrossRefGoogle Scholar
  107. 107.
    Kurella TM, Covinsky KE, Chertow GM, Yaffe K, Landefeld CS, McCulloch CE. Functional status of elderly adults before and after initiation of dialysis. N Engl J Med. 2009;361(16):1539–47.CrossRefGoogle Scholar

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© Springer Nature Singapore Pte Ltd. 2020

Authors and Affiliations

  1. 1.Division of Nephrology, Department of GeriatricsFirst Affiliated Hospital, Nanjing Medical UniversityNanjingChina

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