When KDIGO Meets Frailty: Rethinking CKD Targets in Adults Aged 80 Years and Older - PubMed
4 hours ago
- #Frailty
- #CKD
- #Geriatrics
- Chronic kidney disease (CKD) is highly prevalent in very old adults and often coexists with frailty, multimorbidity, and limited life expectancy.
- Standard KDIGO treatment targets for blood pressure, glycemic control, albuminuria, lipid management, anemia, and CKD-mineral and bone disorder may not be suitable for frail octogenarians and nonagenarians due to altered risk-benefit balance.
- Clinical trials supporting KDIGO recommendations largely excluded very old and frail patients, creating a gap in evidence for this population.
- This narrative review explores CKD progression in frail very old adults, focusing on frailty, geriatric syndromes, and competing risks of end-stage kidney disease (ESKD) and death.
- A pragmatic framework is proposed to adapt KDIGO-style targets by incorporating frailty assessment, life expectancy, and patient goals of care into treatment decisions.
- The review emphasizes individualized treatment ranges, treatment simplification, deprescribing, and prioritizing physical and cognitive function as primary outcomes.
- Urgent research priorities include trials enrolling frail older adults, evaluations of deprescribing strategies, and studies comparing conservative kidney management with dialysis in this vulnerable group.