Geriatric Nephrology is part of a new generation of subspecialties serving a growing population of aging patients who are living longer and more actively with multiple medical problems. Chronic Kidney Disease (CKD), which is a progressive wear and tear of kidney tissue leading to loss of kidney function and the eventual need for dialysis, can remain silent for years. Diseases like diabetes, atherosclerosis, elevated lipids, and hypertension, in conjunction with the aging process, will accelerate this abnormal kidney process. Once it starts, CKD becomes an important risk factor for cardiac and circulation problems, infections, hospitalization, and premature death. It also affects geriatric conditions like frailty, and functional and cognitive decline. Early identification and aggressive intervention can slow the rate of kidney function loss, limit its associated complications, and postpone the need for dialysis.
In the United States, the median age of patients starting dialysis is 64.8 years old. The fastest growing segment of the dialysis population is 75 years and older. This includes nursing home dialysis patients who experience significant morbidity and mortality. It is common for patients not to know what their kidney status is. Some become aware only in the more advanced stages when dialysis decisions have to be made quickly without time for adequate mental preparation. This creates understandable challenges, particularly for elderly patients and their families. Older patients are facing more complicated decisions about how to maximize their quality of life without compromising their integrity and personal autonomy. Dialysis issues in the outpatient and hospital settings have become more complex from both a medical management and a quality of life standpoint.
Geriatric Nephrology, brings a crucial geriatric perspective to the care of elderly kidney patients with varying degrees of frailty, multiple medications, memory and functional impairments, and psychological and family issues. This approach allows patients and their families to better cope with the chronic progressive nature of CKD and its complications. It incorporates geriatric and palliative care principles that emphasize patient independence and functionality, as well as treatment of burdensome symptoms with a holistic focus.
The Mount Sinai Geriatric Nephrology Program offers a multi-dimensional approach to the assessment and treatment of kidney diseases and dialysis issues in patients over the age of 60.
Patients can request an evaluation of their kidney status or be referred by their primary doctor for consultation.
The benefits of geriatric nephrology referral include:
Slowing the progression of chronic kidney disease (CKD) and its associated complications (cardiovascular disease, functional and cognitive decline, frailty, kidney bone disease, anemia, malnutrition), using expert clinical practice guidelines established by the National Kidney Foundation
Improved education of patients and their families about CKD ("Know your creatinine, GFR, blood pressure, urinary protein")
Medication review in the context of CKD (part of "kidney health maintenance")
Better informed choices of renal replacement ("blood" or "peritoneal" dialysis and transplant) options, timelier placement of access, and more appropriate initiation of dialysis
Decreased hospitalization and morbidity
Optimizing kidney status to limit insults in the setting of surgery and new acute medical conditions
For those patients with advanced CKD or who are on dialysis already, our Geriatric Nephrology Program can address and optimize:
Shared decision making among patients and their families about dialysis initiation or withdrawal
Discussion of time-limited dialysis trials in those patients where it is difficult for them or their families to decide
Advance care planning and updated reviews of current medical status in the context of CKD/dialysis, and associated complications, as well as how this has an impact on patient quality of life and goals of care issues
Pain and physical symptom management, in addition to psychosocial and spiritual support using a palliative care approach modified to the needs of this unique population