演題情報

学会・委員会企画

開催回
第62回・2017年・横浜
 

Epidemiological significance of gender and aging on chronic dialysis

演題番号 : GI-01-5

Rajiv Saran:1、Jennifer Bragg-Gresham:1

1:University of Michigan, Ann Arbor, MI, USA

 

In developed nations, with growing life expectancy, nephrology is fast becoming a geriatric subspecialty. This talk will largely focus on the significance of increasing age as well as gender, two of the major demographic characteristics of patients on dialysis. It is well known, that kidney disease is commoner among older age groups as renal function is known to decline with aging, even among the healthy. It is therefore not surprising that with the epidemiologic transitions being observed in both developed and the rapidly evolving developing nations, older individuals are increasingly are arriving at end stage renal disease (ESRD), with significant implications for their management both during the transition and when on dialysis.Some of the mechanisms related to the decline in kidney function with aging may be presented in this talk, e.g., recent advances in podocyte biology. Accelerated aging as seen with chronic diseases such as diabetes, hypertension, cardiovascular disease etc. is the primary reason for the dramatic rise in incidence of kidney diseases throughout the world, with rising burden of non-communicable diseases,particularly in low and middle income countries. Data from the recently released 2016 Annual Data Report of the United States Renal Data System (USRDS) will be presented for incidence and prevalence of ESRD magnitude and trends. Potential reasons for the recent stabilization and perhaps early decline in incidence and rising prevalence will be discussed. Data will be presented by age, race, sex and geography. Modality choice for the elderly is critical and considerations of peritoneal vs. hemodialysis vs. conservative management and issues surrounding palliative care of those with advanced kidney disease will be covered briefly from the US perspective a brief survey of the existing literature. The topic of differences by sex in terms of achieved vascular access type will be presented along with potential reasons why this might be the case. Whether these differences exist by country will be explored. Data on differences in CKD progression among men and women, and by age groups will be presented from published research as well as our own work using data from the Veterans Administration (VA), and discussion of potential underlying reasons as to why globally, the incidence of ESRD and progression of CKD is faster among men compared with women despite the prevalence of CKD being higher among women to begin with. Whether this a biological phenomenon, the result of methods for estimating kidney function, or whether there is a possibility of disparity/unconscious/systematic bias in the management of kidney disease by sex, will be discussed. Finally some new analyses also using data from the VA, showing differential rates of progression by age and eGFR categories will be shown, with potential of informing a future definition of CKD that incorporates different age cut-offs.

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