This article describes the pathophysiology of osteoporosis in chronic kidney disease and the increased risk of fractures. 5 pages. Last reviewed August 2018.

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Chronic kidney disease (CKD) is a decreased level of kidney functioning for a period of three months or more (1). Severity of CKD can vary, but most cases develop slowly without symptoms, are mild or moderate, and do not result in kidney failure (especially if discovered early) (1). People with CKD have an increased risk of developing heart disease or having a stroke (2).

While CKD can develop at any age, it is more common in older adults (2). About half of people aged 75 and older have some degree of CKD, although most of these cases are due to the normal aging process (2).

A routine blood test is commonly done to detect CKD and monitor people with conditions that can affect the kidneys such as diabetes or high blood pressure. Treatment can slow down the progression of CKD and reduce the risk of developing heart disease or having a stroke (2).

References

(1)  The Kidney Foundation of Canada. (n.d.). What is kidney disease? Retrieved from  https://www.kidney.ca/kidney-disease

(2)  Tidy, C. (2017). Chronic kidney disease. Retrieved from http://www.patient.co.uk/health/chronic-kidney-disease-leaflet

There is an age-related decline in kidney function; however, not all individuals will develop chronic kidney disease (CKD) with advancing age.  Those who are genetically predisposed and exposed to lifetime cardiovascular risk factors are likely to develop systemic atherosclerosis and CKD. (1)

Why is it Important?

  • 70.9% of people with CKD have hypertension compared with 20.1% of people without CKD (1)
  • About 1 in 10 people have some degree of CKD and it is more common in women (2)
  • CKD contributes to poor health through its association with inflammation and oxidative stress (1)
  • Malnutrition, weight loss and sarcopenia are common in CKD patients, leading to poor outcomes, such as physical and cognitive dysfunction, manifesting as major geriatric syndromes (1)
  • Frailty is likely to be one of the underlying processes that leads to the clinical manifestations of geriatric syndromes in patients with CKD (1)
  • Functional outcomes, such as cognition and physical functioning, are more relevant outcomes to older patients with CKD (1)
  • Renal function declines physiologically with advancing age and pathologically as a result of associated diabetes mellitus and hypertension (1)
  • Although about half of people aged 75 or more have some degree of CKD, most of these people do not actually have diseases of their kidneys; they have normal ageing of their kidneys  (2)

Key Considerations

  • Interventions should be developed and assessed in terms of maintaining quality rather than quantity of life in order to prevent disability (1)
  • Investigations to exclude treatable kidney disease (e.g. urinary tract infection or obstruction) (2)
  • Reduce progression of kidney disease (by controlling BP to recommended levels with ACEI or ARB therapy) (2)
  • Reduce cardiovascular risk, avoidance of nephrotoxic medications and volume depletion, Lipid-lowering treatment, glycemic control (2)
  • Early detection and management of CKD complications by: avoid renally-excreted medications; adjust medication doses for kidney function and appropriate referral to a nephrologist where indicated (2)

References

1.  Abdelhafiz, A., Ahmed, S., El Nahas, M. & Flint, K.  (2011).  Is chronic kidney disease in older people a new
     geriatric giant? Aging Health, October 2011, Vol. 7, No. 5, Pages 749-762.  Retrieved March 10, 2014 from:
     http://www.medscape.com/viewarticle/753447

2.  Phoon, R. (2012) Chronic kidney disease in the elderly: Assessment and management.  Australian Family
     Physician Volume 41, No.12, December 2012 Pages 940-944. Retrieved March 2014 from:
     http://www.racgp.org.au/download/Documents/AFP/2012/December/201212phoon.pdf

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The Kidney Foundation of Canada is the national volunteer organization committed to reducing the burden of kidney disease by providing funding and stimulating innovative research, providing education and support, promoting access to high quality healthcare, and increasing public awareness and commitment to advancing kidney health and organ donation.

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