Miles Witham is a Clinical Reader in Ageing and Health, University of Dundee, and is an Associate Editor for Age and Ageing journal.
If you are reading this post in having fought through a bad winter, overburdened by emergency admissions and colleague absences, your initial reaction to the title might well be ‘Oh no, yet another area of work that someone wants me to take on’. Having been on call this weekend, I sympathise – but allow me to illustrate why I think that the time has arrived for us as geriatricians to get involved in kidney disease.
Kidney disease is common in older people, and is a particularly common comorbidity in the oldest, frailest patients that we care for. One quarter of the older people I saw on call this weekend had Acute Kidney Injury (AKI), and one half had Chronic Kidney Disease (CKD). And it’s important – it is a major risk factor for cardiovascular disease, adversely affects bone health, makes drug treatment more difficult, and of course leads to hospitalisation and death. For a number of our older patients, advanced kidney disease contributes to their symptom burden and their functional decline. Some of these patients require renal replacement therapy – all of them need good care to ameliorate the symptomatic effects of advanced CKD.
In many other areas of medicine (e.g. heart failure, surgery, cancer and orthopaedics), there is a growing recognition of the value that geriatricians can bring. Just as with other organ-specific problems common in old age, geriatricians are ideally placed to diagnose and manage frailty, take a holistic view of management, and facilitate seamless cross-boundary care for patients.
The good news is that geriatricians have got some willing partners in this endeavour, and collaboration is likely to benefit all groups. There is a growing awareness within the nephrology community that more time and effort needs to be focussed on older people with kidney disease. Acute Kidney injury and conservative therapy in advanced CKD are hot topics, and links with palliative medicine services are growing. The time is ripe therefore for nephrologists and geriatricians to forge closer links – nephrologists are well placed to help us manage the huge burden of CKD (indeed there is no way that they can do this alone), and we are well placed to lend help and expertise in managing multimorbidity, frailty and coordinate complex care. Best of all, nephrologists, like geriatricians, share a mode of practice that pays attention to detail, and are well used to working in large, diverse multidisciplinary teams. There are thus elements of a shared working culture to build on.
Successful, appropriate management of older people with kidney disease and multimorbidity requires a blend of nephrological, geriatric medicine and palliative medicine expertise, both in research, training and clinical practice. A number of forward-thinking departments around the UK are now bringing together more closely these components of care for kidney patients, and at a European level, a large survey is underway to map how older kidney patients are cared for.
To encourage dialogue, research, learning and service development at the interface of these specialties, we are launching a UK network of professionals interested in the care of older people with kidney disease. Geriatricians have a key role to play in this dialogue, and I would encourage all of you with an interest in this area to join the group – whether you have formal input into a renal MDT, an interest in how to manage CKD in your clinic patients, or involvement in caring for older patients in the final stages of advanced kidney disease.
If you, or someone you work with, would like to join us, please email me: email@example.com,; we will add you to the email group, and we hope to involve you in future initiatives to provide the very best care for older patients with kidney disease.