Kidney Disorders

Kidney disorders, whether in the form of renal insufficiency or electrolyte disturbances, are frequently encountered in the care of the geriatric population. Moreover, most older patients, especially over age 75 years, are more likely to die from a cardiovascular event than develop end-stage kidney disease (ESKD) even at severely reduced eGFR less than 30 mL/min/ 66 1.73 m2. In this chapter, we discuss the various disease states, both primary and systemic, that have an impact on kidney function in older adults. We begin by reviewing the natural course of the aging kidney, known as senescence, then transition to describe the key components of CKD care especially in older adults that includes the patient’s experience of illness which is influenced by the presence of comorbid conditions. Therefore, early identification and characterization of acute kidney injury and chronic kidney disease are important to limit the risk for overt kidney failure. Lastly, even in the face of normal or appropriate kidney function in this population, we review the disorders of electrolytes, such as potassium, sodium, and fluid, which are quite -common often related to prescription drugs and polypharmacy. To this end, we review the intersection between pharmacotherapeutics and the different causes of kidney injury, as well as appropriate drug dosing regimens.