Renal physiological aging is characterized by a reduction in the renal glomerular filtration rate. In other words, the kidney does its filtration work in a slower way, in the same way that the locomotion of an elderly person is also slower, but maintaining the preserved function, that is, reaching the same place.
“The elderly are the biggest consumers of medication.”
This situation must be distinguished from the effective presence of kidney disease in the elderly, a situation in which the functioning of the kidneys is not adequate and is not related to the physiological decline of age. In situations of illness, and as in any other young or adult patient, kidney malfunction can be so severe that some interventions are needed. One is the medication review.
The elderly are the biggest consumers of medication, as they also accumulate more pathologies, and some medications can impair kidney function. Pain medications from the group of non-steroidal anti-inflammatory drugs, often taken by the elderly due to their degenerative osteoarticular pathology, can be very harmful and their indications and alternatives reviewed.
The other substantial intervention by the nephrologist is to prepare the patient for renal replacement treatment if and when the kidneys “stop”.
In India, kidney transplant is rarely performed in patients over 65/70 years old, since the risk of intervention and immunosuppression is greater than its benefit. But aging in the elderly is highly heterogeneous: age is of little significance for the decisions to be made, since other more important factors can overlap, such as: associated diseases, functionality, autonomy and independence. Thus, an elderly person may be a candidate for transplantation, despite not being the norm.
“ There are kidney patients who, due to the advanced comorbidities they have, do not benefit, in terms of time or quality of life, from any renal function replacement therapy. “
As for dialysis modalities (hemodialysis or peritoneal dialysis), there is no difference between them, similarly to what happens in young patients. The only point to note is that peritoneal dialysis is a modality that depends on the patient to be performed, unlike hemodialysis that is performed by a nurse in a hemodialysis center. Therefore, if the patient is not able to perform the technique, he may need a caregiver to do it for him, or, if he does not have it, this modality should not be an option.
Finally, there are kidney patients who, due to the advanced comorbidities they present, do not benefit, in terms of time or quality of life, from any renal function replacement therapy. These patients should be offered palliative care. Therefore, patients should be followed up by nephrologist in Delhi in order to control the symptoms of kidney disease, promoting quality of life, but without being subjected to more invasive techniques.
The choice of these options should always be made in conjunction with the assistant kidney specialist in Delhi, who should clarify the particularities of each elderly person, in order to better adapt the treatment to the person in question.