Kidney Disease: A Growing Crisis in Aging Populations

Kidney disease is emerging as one of the most pressing public health challenges in the United States and across the Western world, particularly as aging populations grow. Once regarded as a condition primarily affecting individuals with diabetes and hypertension, chronic kidney disease (CKD) is now a significant concern for older adults, affecting millions and straining healthcare systems.

With rising life expectancy and an increase in chronic illnesses, the prevalence of kidney disease is escalating, often leading to costly long-term care needs. Experts warn that without greater awareness, earlier detection, and improved treatment strategies, CKD will continue to burden the healthcare infrastructure and diminish the quality of life for aging individuals.

Nephrologists and Early Intervention

Nephrologists are specialists in kidney health and play a vital role in diagnosing and managing CKD. Primary care physicians and other specialists frequently refer patients to nephrologists when early signs of kidney dysfunction appear, allowing for timely intervention. These specialists conduct comprehensive evaluations, monitor kidney function, and help prevent the disease from progressing to more severe stages.

Early referral to a nephrologist is crucial, particularly for older adults, as kidney function naturally declines with age. You can find a top nephrologist in San Antonio or where you live by asking your primary physician, asking friends or family, and doing an internet search for providers in your area.

According to the Centers for Disease Control and Prevention (CDC), nearly 40% of individuals over 65 have some level of CKD, making regular kidney function testing a necessity for this demographic.

Common Medications for CKD Management

Managing CKD often involves a combination of lifestyle modifications and medications. Some of the most commonly prescribed drugs for CKD include:

• Angiotensin-Converting Enzyme (ACE) Inhibitors (e.g., Lisinopril, Enalapril) – Help lower blood pressure and protect kidney function.
• Angiotensin II Receptor Blockers (ARBs) (e.g., Losartan, Valsartan) – Alternative to ACE inhibitors for patients with high blood pressure and kidney disease.
• Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitors (e.g., Dapagliflozin, Empagliflozin) – Originally developed for diabetes, these drugs have shown promise in slowing CKD progression.
• Diuretics (e.g., Furosemide, Hydrochlorothiazide) – Help control blood pressure and reduce fluid buildup.
• Phosphate Binders (e.g., Sevelamer, Lanthanum Carbonate) – Used to manage high phosphate levels in patients with advanced kidney disease.

With advancements in treatment and patient education, nephrologists are helping patients live longer, healthier lives despite kidney disease.

The Scope of the Problem

According to the National Kidney Foundation, approximately 37 million Americans have chronic kidney disease, yet as many as 90% of those affected are unaware of their condition. In Europe, the numbers are similarly alarming, with an estimated 10% of adults experiencing some form of kidney impairment. In older populations, the risk is even greater—nearly 40% of individuals over 65 have some level of CKD.

Kidney disease often progresses silently, with symptoms only becoming evident in advanced stages. This lack of early warning signs makes routine testing crucial, particularly for individuals with risk factors such as diabetes, high blood pressure, obesity, and a family history of kidney disease.

Causes and Risk Factors

While genetics can play a role in kidney disease, lifestyle, and comorbid conditions are major contributors. Some of the most common causes include:

• Diabetes: High blood sugar levels damage the kidneys over time, making diabetes the leading cause of CKD.
• Hypertension: Chronic high blood pressure weakens blood vessels in the kidneys, impairing their ability to filter waste.
• Obesity: Excess weight increases the risk of diabetes and hypertension, both of which contribute to kidney disease.
• Heart Disease: Cardiovascular conditions are closely linked to kidney function, as the heart and kidneys work together to regulate bodily fluids and blood pressure.
• Smoking and Poor Diet: Smoking exacerbates kidney damage, while high-sodium and high-fat diets contribute to hypertension and diabetes.
• Aging: As the body ages, kidney function naturally declines, increasing the risk of CKD.

Symptoms and Diagnosis

Because kidney disease progresses gradually, symptoms often appear when significant damage has already occurred. Common signs include:

• Fatigue and weakness
• Swelling in the legs and ankles
• Difficulty concentrating
• Persistent itching
• Shortness of breath
• Frequent urination, especially at night
• Loss of appetite and nausea

Diagnosis typically involves blood and urine tests. A blood test measuring creatinine levels helps estimate the glomerular filtration rate (GFR), which indicates how well the kidneys are functioning. Urinalysis can detect protein leakage, another early marker of kidney damage.

Treatment Options and Management

While there is no cure for chronic kidney disease, early detection can slow its progression and prevent complications. Treatment varies based on the severity of the disease:

• Lifestyle Modifications: Dietary changes, exercise, and weight management are essential for controlling risk factors such as diabetes and hypertension.
• Medications: Blood pressure medications like ACE inhibitors and ARBs help protect kidney function. Sodium-glucose cotransporter-2 (SGLT2) inhibitors, initially developed for diabetes, have shown promise in slowing CKD progression.
• Dialysis: In advanced cases, dialysis becomes necessary to remove waste and excess fluid from the body. Hemodialysis and peritoneal dialysis are the two primary methods used.
• Kidney Transplant: For eligible patients, a kidney transplant offers the best long-term outcome, though donor shortages remain a challenge.

Impact on Aging and Long-Term Care

As kidney disease progresses, the need for long-term care increases. Many older adults with CKD require assisted living or skilled nursing care due to mobility issues, cognitive decline, and complications such as heart disease and stroke.

Long-term care facilities must adapt to the growing prevalence of CKD by providing specialized dietary plans, medication management, and dialysis support. Home healthcare services are also expanding to accommodate aging patients who prefer in-home dialysis over institutional care.

Find quality long-term care services for a loved one with kidney problems using the LTC News Caregiver Directory. With over 80,000 providers nationwide, you can easily search and find the best care option to meet their needs.

The financial burden of kidney disease is substantial. According to the Centers for Medicare & Medicaid Services, CKD-related healthcare costs exceed $120 billion annually in the U.S. alone.

For older adults with other aging or chronic health issues, long-term care is also costly but not covered by health insurance and Medicare. Unfortunately, not everyone has Long-Term Care Insurance to pay these rapidly increasing costs.

This underscores the need for preventive measures and early intervention to reduce long-term expenses and improve patient outcomes.

Preventive Strategies and Public Health Initiatives

Public health efforts are increasingly focused on early detection and prevention. Organizations like the National Kidney Foundation, the American Kidney Fund, and European kidney health initiatives emphasize the importance of routine screenings, especially for high-risk populations.

Preventive strategies include:

• Expanding awareness campaigns to educate the public about CKD risk factors
• Encouraging regular kidney function tests for those over 60 (some suggest even younger)
• Promoting healthier diets and lifestyle choices
• Supporting research into new treatments and therapies

Looking Ahead

With kidney disease on the rise, healthcare providers, patients, and families must work together to combat this silent epidemic. Early detection, effective management, and increased awareness can significantly improve outcomes for those at risk.

Planning for long-term care is essential as we age. Whether facing chronic illnesses like CKD, mobility challenges, dementia, or frailty, the need for quality care services continues to grow with increasing longevity. Most people plan as part of an overall retirement strategy.

Taking proactive steps—through lifestyle choices, medical care, and insurance planning—can help protect kidney health and ensure a better quality of life in later years.