title: OLDER PEOPLE WITH CHRONIC KIDNEY DISEASE: DEFINITION, AND INFLUENCE OF BIOMARKERS AND MEDICATIONS UPON CARDIOVASCULAR AND RENAL OUTCOMES.
abstract: BACKGROUND
  Chronic kidney disease (CKD) is a global problem. With an ageing population the burden on the health services has increased due to the growing number of older people with CKD. This group of individuals is far different to the younger CKD population and their risk of cardiovascular death is far greater than the risk of progressing to end stage kidney disease (ESKD).
  
  
  OBJECTIVE
  In this review we explore the role of certain biomarkers and medications in predicting the risk of progression to ESKD and death in old people with CKD.
  
  
  METHODS
  An electronic literature search of EMBASE and MEDLINE databases was performed using Healthcare Databases Advanced Search (HDAS) in December 2014.
  
  
  RESULTS
  Albuminuria is a key biomarker in predicting the risk of death and progression to ESKD. Cystatin C appears to be superior in predicting the risk of cardiovascular and non-cardiovascular death compared to GFR or creatinine. Several inflammatory biomarkers can be used to predict the risk of death and progression to CKD but measuring and monitoring them in routine clinical practice will be expensive and impractical. The effects of long-term RAAS inhibition in older people are not well established. Older people especially those with CKD receive suboptimal secondary preventive measures. Due to multiple comorbidities older people with CKD are usually receiving a number of medications. This can potentially lead to significant adverse drug events (ADE) due to drug interactions.
  
  
  CONCLUSIONS
  Novel non-traditional risk factors like albuminuria, Cystatin C and inflammatory biomarkers play an important role in predicting their risk of death and progression to ESKD. The efficacy and safety of medications in older people with CKD is not well established and requires more extensive, focused study.
authors.affiliation: Vascular Research Group, Salford Royal NHS Foundation Trust, Salford, UK.|Institute of Population Health, University of Manchester, Manchester, UK.
authors.forename: Maharajan
authors.initials: M
authors.lastname: Raman
authors.affiliation: Vascular Research Group, Salford Royal NHS Foundation Trust, Salford, UK.|Institute of Population Health, University of Manchester, Manchester, UK.
authors.forename: Darren
authors.initials: D
authors.lastname: Green
authors.affiliation: Vascular Research Group, Salford Royal NHS Foundation Trust, Salford, UK.|Institute of Population Health, University of Manchester, Manchester, UK.
authors.forename: Rachel J
authors.initials: RJ
authors.lastname: Middleton
authors.affiliation: Vascular Research Group, Salford Royal NHS Foundation Trust, Salford, UK.|Institute of Population Health, University of Manchester, Manchester, UK.
authors.forename: Philip A
authors.initials: PA
authors.lastname: Kalra
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D000419:Albuminuria / Q000652:urine; D015415:Biomarkers / Q000032:analysis* / Q000097:blood / Q000652:urine; D055316:Cystatin C / Q000032:analysis / Q000097:blood; D006801:Humans; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000401:mortality*; D006113:United Kingdom
chemical_list: D015415:Biomarkers; D055316:Cystatin C
keywords: Biomarkers; Chronic kidney disease; Medications; Old people; Outcomes