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Although considerable interest continues to mount on diseases of the elderly, there is no universally accepted definition of elderly particularly in patients with chronic kidney disease (CKD). In 1935, the USA passed the first Social Security Act, using age 65 years as the age of retirement and the age at which a person became eligible for government welfare benefits [1]. Since then, being above 65 years old is largely accepted as being elderly. The proportion of the US population over the age of 65 years has increased from 4% (approximately 3 million in a population of 65 million) in 1900, to 12% (35 million in a population of 280 million) in the year 2000 [2]. The proportion of the elderly is predicted to further rise to 20% by the year 2030 [3]. Worldwide the median age of the world's population has increased, due to a decline in fertility with fewer births and a 20-year increase in the average life span in the second half of the 20th century [4]. Overall the demographic change from a pattern of high birth rates and high mortality to low birth rates and delayed mortality has contributed to the rise in the elderly population [5]. Given the rise of the aging population, and implications on diagnosis and management of the elderly with CKD, as of 2005 the Accreditation Council for Graduate Medical Education included geriatric nephrology training in the core curriculum for nephrology fellowship [6].
Prevalence of CKD in the elderly
There is a high prevalence of CKD in the elderly. This is attributable mainly to increasing prevalence of traditional risk factors for CKD such as diabetes, [7] hypertension and cardiovascular disease (CVD) as well as due to new definitions that have expanded the estimated glomerular filtration rate (eGFR) range for CKD. These new definitions for CKD are kidney damage evidenced by abnormal renal markers or a reduction of the absolute eGFR to less than 60 ml/min/1.73 m 2 for at least 3 months. Abnormal renal markers are proteinuria, abnormal radiology, abnormal cells in the urine or renal pathology on biopsy. In addition, a history of renal transplantation is included in the definition [8]. These definitions were derived from studies of the Third National Health and Nutrition Examination Survey...