Kidney Disease/Renal Failure

Kidney disease, sometimes referred to as chronic kidney disease (CKD), is prevalent among older adults due to age-associated renal function decline, compounded by the presence of comorbidities like hypertension and diabetes. Renal failure, the end-stage of CKD, occurs when the kidneys no longer perform their vital functions, necessitating dialysis or transplantation. In post-acute and long-term care (PALTC) settings, managing kidney disease requires a multidimensional approach.

Understanding Kidney Disease in Older Adults

• Staging and Progression: CKD is categorized into stages (1-5) based on glomerular filtration rate (GFR). The final stage, known as end-stage renal disease (ESRD), may necessitate treatments like hemodialysis.
• Manifestations: Aside from reduced urine output, CKD can manifest as fatigue, anemia, bone disorders, fluid retention, and cardiovascular complications.

Strategies for Comprehensive Management

• Regular Monitoring: Estimating GFR and assessing urine protein levels are foundational. Monitoring electrolytes, especially potassium and phosphate, helps guide dietary and medication adjustments.
• Medication Management: Recognizing and minimizing nephrotoxic drugs, adjusting drug dosages based on kidney function, and utilizing medications to manage CKD complications, such as anemia or mineral bone disorders, are integral.
• Dietary Adjustments: Tailored dietary interventions, focusing on protein, sodium, potassium, and fluid restrictions, can decelerate CKD progression and manage symptoms.
• Dialysis Considerations: Deciding on dialysis initiation in PALTC residents requires a balance between expected benefits and the burdens of treatment. Options include in-center hemodialysis, peritoneal dialysis, or even conservative management without dialysis.
• End-of-Life Discussions: Engaging in timely discussions regarding prognosis, treatment options, and end-of-life preferences is pivotal, especially as ESRD approaches.
• Interdisciplinary Collaboration: A synergistic approach involving nephrologists, dieticians, social workers, and palliative care teams can address the multifaceted needs of CKD patients.