Reasons Kidney Function Decreases In Seniors
By Matthew Princiotto 9 am on February 28, 2019
The kidneys are an essential part of the bodys waste-removal system. They filter liquids, allowing hydrating water to flow throughout the body while waste products are disposed of in the urine. The kidneys are among the organs seniors have the most problems with as they age. Kidney function tends to decrease with age due to these five reasons.
Structural Changes Of The Aging Kidney
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Chronic Kidney Disease Stages
Risk factors for kidney disease include diabetes, high blood pressure, family history, older age, ethnic group and smoking.For most patients, a GFR over 60 / is adequate. But significant decline of the GFR from a previous test result can be an early indicator of kidney disease requiring medical intervention. The sooner kidney dysfunction is diagnosed and treated the greater odds of preserving remaining nephrons, and preventing the need for dialysis.
|Stage 5||< 15|
The severity of chronic kidney disease is described by six stages the most severe three are defined by the MDRD-eGFR value, and first three also depend on whether there is other evidence of kidney disease :
- 0) Normal kidney function â GFR above 90 / and no proteinuria
- 1) CKD1 â GFR above 90 / with evidence of kidney damage
- 2) CKD2 â GFR of 60 to 89 / with evidence of kidney damage
- 3) CKD3 â GFR of 30 to 59 /
- 4) CKD4 â GFR of 15 to 29 /
- 5) CKD5 kidney failure â GFR less than 15 / Some people add CKD5D for those stage 5 patients requiring dialysis many patients in CKD5 are not yet on dialysis.
Note: others add a “T” to patients who have had a transplant regardless of stage.
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Procedures And Low Kidney Function
Diet modification and medications can help delay the progression of chronic kidney disease, especially in the early stages. If the disease progresses, however, other forms of treatment may become necessary.
Other forms of treatment may include:
- Blood transfusions: Hormone and iron supplements are not always enough to manage the symptoms of anemia. In those cases, your doctor may order one or more blood transfusions.
- Dialysis: Dialysis is an artificial method of removing wastes, toxins, and excess fluids from your blood when your kidneys cease to function. There are two types of dialysis: hemodialysis and peritoneal dialysis.
- With hemodialysis, your blood is filtered through a machine to be cleansed of impurities and then returned to your body.
- With peritoneal dialysis, a thin tube is inserted into your abdomen, which you fill with a solution that absorbs wastes and extra fluids. After a specified period of time, the solution is drained, and the wastes are removed.
Calorie Restriction And Activation Of Sirtuins
Calorie restriction consists of established dietary interventions that have been shown to increase both the median and maximum lifespan of a variety of species, including yeast, fish and mammals., The health benefits of calorie restriction have also been demonstrated in primates calorie restriction in rhesus monkeys blunts aging and significantly delays the onset of age-related disorders, including cancer, diabetes, cardiovascular disease and brain atrophy.
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How Is Your Glomerular Filtration Rate Measured
The glomerular filtration rate measurement comes from the name of the filtering units inside your kidneys, called the glomeruli.
Glomeruli are complex structures made of tiny blood vessels called capillaries, along with protein mesh and layers of tissue that continuously filter your plasma. Each glomerulus is housed within a structure called a Bowmans capsule. Based on 2020 research, between your 2 kidneys, you have about 2 million glomeruli.
A number of formulas are used by groups like the National Kidney Foundation to calculate GFR. But the measurement essentially takes into consideration your gender, age, body size, and your blood creatinine level.
- 0.9 to 1.3 milligrams per deciliter in adult men
- 0.6 to 1.1 milligrams per deciliter in adult women
These levels can vary. For example, in a 2009 research review, creatinine levels fell by an average of 0.4 milligrams per deciliter in pregnant women.
Because they can change with age and size, creatinine levels alone are not good indicators of kidney health. The GFR takes these other elements into account.
Most GFR results simply provide you with a measurement of 60 or higher, since you can have stage 1 or 2 kidney disease, but still have normal kidney function. This changes when your GFR drops below 60. Under 60, you begin to have some loss in function.
When To Worry About Creatinine Levels And Kidney Failure
What Level Of Creatinine Indicates Kidney Failure And When To Worry About Creatinine Levels? The normal creatine level is different in males and females. In the female, the normal level of creatinine is 0.6 to 1.1 mg/dl while in male, the level of 0.8 to 1.3 mg/dl is considered normal. The creatinine levels are also affected by race.
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Additional File : Figure S1
Flow diagram of the selection of study participants. Figure S2. Baseline systolic blood pressure and loss of kidney function according to age groups. Figure S3. Risk factors for loss of kidney function and differences from the mean estimated glomerular filtration rate slopes according to age . Figure S4. Risk factors for loss of kidney function and differences from the mean estimated glomerular filtration rate slopes according to age .
Creatinine Renal Handling In The Elderly
Classically, it has been described that renal creatinine excretion in humans is the result of two physiological processes: glomerular filtration and proximal tubular secretion . However, there are certain physiological situations, such as in the case of healthy newborns and premature babies, and dehydrated adults, in which tubular creatinine reabsorption has been documented . Despite the finding of a classical study by Rowe et al. that showed that tubular secretion of creatinine did not change with normal aging, in a recent report, Musso et al. documented a net creatinine reabsorption in the renal tubules of healthy old persons. It is possible that the senile tubular changes make the aged tubules more susceptible to creatinine reabsorption as it happens in newborns, but in this case due to tubular immaturity . This creatinine reabsorption pattern turns into a secretion one in the setting of severe chronic renal disease .
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Selection Of Participants And Baseline Characteristics
Of 133,925 individuals who underwent a medical examination in Kanazawa City between 1999 and 2013, 51,938 met the eligibility criteria and were included in the analysis . The median follow-up period was 4.0years.
Table shows the participants baseline characteristics. The group with the highest number of participants was the 6069years age group . Lower eGFR and higher blood pressure were observed in the older group, and more than half of the participants aged 70years were treated for hypertension. Nearly half of the participants in the age group of 80years had an eGFR of < 60mL/min/1.73m2. All groups showed quite similar levels of hemoglobin, BMI, and total cholesterol. Diabetes mellitus, history of coronary artery disease, and history of stroke were more frequent in older people than in younger people. The proportion of current smokers was the highest in the youngest group .
Table 1 Baseline characteristics of study population
Older Adults With Kidney Disease
Kidney problems are very common in older adults and can significantly diminish the quality of life in ones later years or even be fatal. While most patients can work with their primary care physicians to manage the symptoms and complications of decreased kidney function, for some patients it is important to consult with a team including both nephrology and geriatric medicine specialists to determine the underlying cause, manage worsening symptoms and complications, and evaluate treatment options. Those include patients with new onset of abnormalities in the urine and loss of kidney function , systemic diseases that can affect the kidneys, and patients with advanced loss of kidney function approaching kidney failure.
Michigan Medicines Geriatric Kidney Disease Clinic was established to help older patients and their caregivers navigate the challenges of acute and chronic kidney conditions.
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How Low Is Low
A healthy kidney filters wastes from the blood at a rate of 90 milliliters per minute or more. This is known as the glomerular filtration rate, or GFR. With time, many men’s kidneys start to slip, but function must decline quite a lot before you start to really feel the impact. You feel fine up to the point that kidney function is almost gone, which means you can lead a normal life with reduced kidney function.
On the other hand, lack of early warning from symptoms can deny you the chance to slow the slide. Most people don’t start feeling really ill until kidney function is under 10%.
What Does A Decreased Kidney Function Mean To My Health
It’s a natural part of aging, so your kidneys decline as you age by as much as 1 ml/min in your eGFR. You may think that means you will eventually need to be on dialysis, but for most people over the age of 65, unless they have a related condition like protein in their urine, they are unlikely to develop further problems beyond stage 3 kidney disease and progress to dialysis. When scientists’ studied who progressed to needing dialysis, they found that people who had a lower eGFR , had anemia, and more protein in their urine. Most likely to not progress to further stages of kidney disease were women, with a lower risk of high blood pressure and a lower level of protein in their urine.
This means that if you are older and have kidney disease you should continue to work with your doctors to assess what changes you can make whether it is adding a medication or seeing a specialist. You still need to be proactive with your health to keep from progressing beyond stage 3 kidney disease.
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Kidney Gfr Chart By Age And Ckd Stages Table
Synopsis: Chart of Kidney Glomerular Filtration Rate number according to your age, includes table showing chronic kidney disease stages. Your GFR number tells you how much kidney function you have, as kidney disease gets worse, the GFR number goes down. “Normal” GFR is approximately 100 but you will often see it reported as > 90 or > 60 . The normal range of Kidney Glomerular Filtration Rate is 100 to 130 mL/min/1.73m2 in men and 90 to 120mL/min/1.73m2 in women below the age of 40.
Symptoms Of Kidney Disease
Kidney disease is called a silent disease as there are often no warning signs. People may lose up to 90 per cent of their kidney function before getting any symptoms. The first signs of kidney disease may be general and can include:
- high blood pressure
- changes in the amount and number of times urine is passed
- changes in the appearance of urine
- blood in the urine
- puffiness of the legs and ankles
- pain in the kidney area
- have a family history of kidney failure
- have a history of acute kidney injury
- are of Aboriginal or Torres Strait Islander origin.
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How Is It Tested
As part of standard blood tests, your doctor can check the creatinine level to assess kidney function. Creatinine is released from muscle cells into the blood stream.
Creatinine is one of the things that the kidneys filter from the blood. If the kidneys start to lose some function, blood creatinine level rises. The creatinine level is used to calculate an estimate of the GFR and provide an estimate of your kidney function.
Most people who have a minor reduction in kidney function can take steps to not keep the kidneys from getting worse. If the function is somewhat low but stable, you may need to see your doctor only once per year. If the GFR is declining or it is already under 50, it’s best to see a kidney doctor, if for no other reason than to become educated.
How high blood pressure damages the kidneys
High blood pressure can cause tiny cracks in the lining of arteries, which provide a breeding ground for fatty deposits that hamper blood flow. As the arteries that feed blood to the kidneys narrow, the body produces renin, a hormone that makes small arteries narrow further. This worsens high blood pressure, causing even more kidney damage. Over time, restricted blood flow can damage or destroy the nephrons, the tiny filtering units inside your kidneys.
What Causes Gfr To Decrease
Kidney disease has been affecting people worldwide and the condition remains undetected and untreated for long years. An acute or chronic kidney problem is normally detected with routine urine or blood tests. If any further you need to detect any abnormality, then it is important to go for further investigation of the underlying causes. Once you know what caused you reduced kidney function, you can initiate management and the treatment for kidney deterioration.
The glomerular filtration rate is extremely helpful to measure the level of kidney function. It is a measure of how much damage has been made to the kidneys and determines which stage of kidney disease you are in. The earlier the detection, the better are the chances of slowing down the progression of kidney disease into a chronic problem.
The blood creatinine level is another measure of kidney function. This chemical waste is produced after muscle metabolism and stays in your blood only. By the way, your kidneys are bound to eliminate an excess of creatinine from the blood, but if they start to compromise with their working, the creatinine level in the blood rises. Besides, creatinine is affected by various factors such as age, gender, and the type of physical activity you do. Hence, compared to blood creatinine levels, the GFR provides a much accurate measure of kidney function.
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Slope Of Egfr And Relationships Between Risk Factors
The adjusted mean eGFR slope in all participants was 0.39mL/min/1.73m2 per year. Significant declines in kidney function were observed in the 60years age groups . Most of the known risk factors were associated with a significantly faster decline in eGFR, except for higher total cholesterol, which was related to a slower decline in eGFR . Proteinuria, current smoking, and diabetes mellitus were associated with a greater decline in eGFR . Similarly, Higher systolic blood pressure and lower hemoglobin were associated with a greater decline in eGFR .
Table 2 Adjusted mean slope according to age groups
Estimating Kidney Function In The Aging Adult
Srinivas Subramanian, MD, Sunil Dhar, MD, Francia Rojas-Delgado, MD, Madhu Kandarpa, MD, Kiran Samindla, MD, and Eric Bloom, MD
Citation:Subramanian S, Dhar S, Rojas-Delgado F, Kandarpa M, Samindla K, Bloom E. Estimating kidney function in the aging adult. Clin Geriatr. 2009 17.
It is expected that 1 in 5 persons will be elderly by the year 2030.1 Chronic kidney disease is an important problem in the elderly and is associated with a high risk of kidney failure, cardiovascular disease, and death.2 Among persons age 60-69 years, approximately 18% have albuminuria and 7% have an estimated glomerular filtration rate of less than 60 mL/min/1.73 m2. In persons age 70 years or older, those percentages increase to 30% and 26%, respectively.3 The severity of CKD can be classified according to the level of the GFR, regardless of the cause, as follows3:
Stage 1: Kidney damage with a normal or increased GFRStage 2: Kidney damage with a mild decrease in GFRStage 3: A moderate decrease in GFRStage 4: A severe decrease in GFRStage 5: Kidney failure
According to the National Kidney Foundation, the average estimated GFR in different age groups is3:
- Age 20-29: 116 mL/min/1.73 m2
- Age 30-39: 107 mL/min/1.73 m2
- Age 40-49: 99 mL/min/1.73 m2
- Age 50-59: 93 mL/min/1.73 m2
- Age 60-69: 85 mL/min/1.73 m2
- Age 70 years and older: 75 mL/min/1.73 m2
—–The following case reveals the dilemma that clinicians face when attempting to accurately estimate kidney function in the elderly patient.
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Senile Decrease In Gfr Differs From That In Chronic Renal Disease
It is important to emphasize that even though the aged kidney has a decreased GFR, it differs in many ways from that in patients with chronic renal failure. Thus, healthy very old persons and patients with CKD share two main physiological characteristics: a similarly low GFR , and a diminished ability for salt and water reabsorption from the renal tubule. However, despite these similarities, the aged kidney and the chronically damaged one differ markedly in a number of physiological aspects described below :
Proximal tubular function is preserved in the healthy oldest old and their serum erythropoietin and hemoglobin levels are normal. Conversely, anemia secondary to a low serum erythropoietin secretion is one of the main characteristics in CKD patients .
Even though the fractional excretion of urea is increased in both settings, serum urea level is normal in the elderly while it is increased in chronic nephropathy .
Serum levels and FE of calcium, magnesium and phosphorus are normal in the healthy very old population, while CKD patients usually have increased FE of these substances, in the presence of normal magnesium, low calcium and high phosphorus serum levels. Parathyroid hormone and active vitamin D levels are normal in the healthy oldest old, while the former is increased and the latter is decreased in the CKD population .