Outcomes in CKD: What We Know and What We Need to Know

Chronic kidney disease (CKD) is a major public health concern. The high prevalence of reduced estimated glomerular filtration (eGFR) in the elderly has led to speculation as to whether it should really be regarded as a disease in all. Patients with CKD exhibit considerable cardiovascular morbidity and mortality but until recently data regarding the natural history of CKD, particularly in the elderly, has been somewhat lacking. As such the clinical significance of K/DOQI's CKD definition in terms of additional morbidity, mortality and progression to end-stage renal disease (ESRD) remains uncertain. Data have shown that death from cardiovascular disease is far more common than progression to renal replacement therapy in the elderly. Factors which increase the risks of progression to ESRD include younger age, proteinuria and diabetes. Although the elderly have high rates of cardiovascular death, comparatively younger patients with CKD have substantially increased relative risks of death. Specialist renal review should be targeted towards these high-risk patients while the majority of elderly patients can be safely monitored in primary care. It remains doubtful whether labelling all elderly CKD patients with a 'disease' confers any additional benefit.