185more probably reflect individuals with chronic kidney disease than not. While this
has been characterized as the “physiological” decrease of glomerular filtration rate
with age, a diagnosis of chronic kidney disease in the elderly has serious prognostic
implications. Mortality of elderly individuals increases as glomerular filtration rate
decreases, as in younger individuals (Fig. 12.3) [ 5 ]. However, while the relative
increase in risk of death with decreasing glomerular filtration rate or increasing
albuminuria may be higher in younger individuals, the absolute increase in risk is
much higher in the elderly since their baseline risk is already higher than in younger
population.
Blood Pressure Targets in the Elderly
During aging, both systolic blood pressure and pulse pressure progressively increase.
It is important to note that there is no consensus among different guidelines for blood
pressure targets in the elderly and even less in the elderly with chronic kidney disease.
In part this is due to a scarce evidence base since the elderly and patients with chronic
kidney disease are frequently excluded from clinical trials.
≥75 years014015 60 90 120Mortality rate /1000person-yearsEstimated glomerular filtration rate
(ml/min/1.73 m^2 )≥75 years01402,5 30 300 1000
Albuminuria (mg/g creatinine)Mortality rate /1000person-yearsA)B)Fig. 12.3 Mortality of
older people according to
glomerular filtration rate.
(a) Mortality rate
according to glomerular
filtration rate and
(b) mortality rate
according to urinary
albumin: creatinine ratio
(Elaborated with data from
Hallan et al. [ 5 ])
12 Resistant Hypertension in Elderly People with Chronic Kidney Disease