Treating elderly people with diabetes and stages 3 and 4 chronic kidney disease.
Dedicated European and US clinical guidelines for type 2 diabetes in the elderly have been released, but they do not specifically address the issue of advanced chronic kidney disease (CKD) in older patients with diabetes. General clinical guidelines have been published on the treatment of patients with diabetic nephropathy (DN), but these address the issue of how to prevent progression and treat advanced DN without distinguishing between different age groups. Elderly patients with diabetes and stages 3 to 4 CKD have particular needs that differ from those of younger patients with the same conditions. This is mainly due to their frailty and shorter life expectancy. Differently tailored therapeutic strategies are needed, which may have less stringent targets; and the use of common drugs should be critically evaluated. The management agenda (metabolic control, low-protein diet, controlling BP, preventing progression of advanced DN, preventing cardiovascular outcomes) for these patients is discussed in light of the limits and perspectives of current guidelines. Intensive, simultaneous management of all items on the agenda may not be feasible for a proportion of older patients, and clinicians may have to give priority to reducing some risk factors rather than others, choosing between different therapies.
Abaterusso
Cataldo
C
Division of Nephrology, Department of Biomedical and Surgical Sciences, University Hospital of Verona, Verona, Italy.
Lupo
Antonio
A
Ortalda
Vittorio
V
De Biase
Vincenzo
V
Pani
Antonello
A
Muggeo
Michele
M
Gambaro
Giovanni
G
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control; D002908:Chronic Disease; D003131:Combined Modality Therapy; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000628:therapy*; D003928:Diabetic Nephropathies / Q000209:etiology / Q000628:therapy*; D018450:Disease Progression; D006801:Humans; D008875:Middle Aged; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011788:Quality of Life; D012720:Severity of Illness Index; D016896:Treatment Outcome