Diabetic Kidney Disease in Elderly Individuals

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Key points

  • Elderly individuals represent the fastest growing subgroup of the US general population, and diabetes mellitus is now a major health issue affecting them.

  • Chronic kidney disease complicates diabetes and also has an increased prevalence in elderly individuals.

  • The kidneys are among the most prominent body organs affected by both the aging process and by diabetes.

Pathophysiology

The kidneys are among the most prominent body organs affected by both the aging process and by diabetes. Kidney function and morphology are known to change with age. The kidney biopsy of a healthy elderly individual may include pathologic findings that have been considered a nonspecific part of the normal aging process.13 Common findings in kidney biopsies of elderly individuals, variable in severity, include advanced vascular changes, fibrosis related to collagen accumulation and global

Treatment

The standards of therapy for diabetic nephropathy in the general population are the triad of blood glucose control, blood pressure control, and administration of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARBs). The goals that have been established through clinical studies are a hemoglobin A1c (HbA1c) of less than 7%, a blood pressure of less than 130/80, and reduction of total urine protein to less than 500 mg/g of creatinine, or of urine albumin to less

Comprehensive therapy

It should not be surprising, based on this information, that little is known about the risks/benefits of multiple combined therapies for diabetic CKD in elderly individuals. One study from Scotland by Joss and colleagues66 of 90 patients whose mean age was 63 years (57% men and 43% women) showed the potential importance of aggressive intervention. The study was a prospective randomized controlled study. Patients with type 2 diabetes and nephropathy were randomly allocated to an intensive group (

Summary

The treatment of diabetic nephropathy in elderly individuals is based primarily on data from younger age groups. However, the assumption that the same treatment approaches for the younger age groups can be uniformly applied to elderly individuals is likely to be incorrect. The cornerstones of aggressive therapy for diabetic kidney disease in general may have drawbacks in elderly patients. For example, significant risks of tight glycemic control have emerged in recent studies. Excessive decrease

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