Treat, Don't Accept Kidney Disease

The role of chronic kidney disease (CKD) in deaths among older adults has been a source of controversy in the medical community.

The debate: Is this a treatable disease process that puts those 75 and older at a greater risk of death than other seniors, or is kidney damage simply a natural part of the aging process?

Research by Bloomberg School scientists leading the global Chronic Kidney Disease Prognosis Consortium, resolved the issue with definitive findings published December 12, 2012, in JAMA. In older adults, CKD increases the risk of death, according to the study, which implies a call to action by researchers and clinicians.

The refuted view attributes CKD to so-called “normal aging,” citing the prevalence of this disease that affects 54 percent of adults ages 75 and up. “That certainly is not the case,” says Josef Coresh, MD, PhD ’92, MHS ’92, the Consortium’s principal investigator and an Epidemiology professor. “We have assembled the world’s data and the data spoke clearly.”

The study analyzed data from more than two million people ages 18 to 108 participating in 46 cohort studies conducted from 1972 to 2011.

Coresh, Kunihiro Matsushita (right), MD, PhD, and other investigators determined that in a comparison between two groups of 1,000 people 75 and older—one group with CKD, the other without—27 more people will die in the first group than in the second. The excess risk is present in all age groups but actually increases  with age.

The study calls for increased attention from health care providers in identifying and managing CKD in older patients, who may be more vulnerable to adverse drug interactions—and are at greater risk of complications from conditions such as high blood pressure and diabetes.

“With kidney disease, risk of many causes of death is higher at every age,” says Coresh. “It’s important to address this higher risk.”