IS GERIATRIC NEPHROLOGY DIFFERENT FROM GENERAL NEPHROLOGY?
- Physiological changes occur with the aging and involve most of the organ systems in the body. Changes (both anatomically and physiologically) occur in the kidneys, resulting in a decline in renal function of 0.75 mL/min per year, even in the absence of common co-morbidities: hypertension and diabetes. Among the anatomic changes are decreased renal mass; decreased glomeruli and glomerular structural changes; tubulo-interstitial fibrosis, scarring, and infarction; and changes in vascular responsiveness and auto-regulation. Physiologic changes include decreased blood flow, glomerular filtration rate (GFR), and diluting and concentrating capacity.
- Increased utilization of healthcare services and resources occur in older adults. Among all the medical co-morbidities, kidney disease and its associated complications are medically and fiscally challenging. Medicare spending on chronic kidney disease for 65 plus aged patients exceeded $ 50 billion in 2013.
- Nephrologists will therefore see an increased number of older patient population. Current Nephrology training doesn’t incorporate geriatric medicine aspects and it will be a challenge for nephrologists to address geriatric medical issues.
- Therefore it is important to know about geriatric medicine and corresponding interaction with nephrology for optimization of patient care and better healthcare outcomes.
Recognizing the importance of this issue to physician training and patient care, the American Society of Nephrology (ASN) convened the ASN Geriatrics Task Force. Co-chaired by Dimitrios G. Oreopoulos, MD, PhD, and Jocelyn Wiggins, BM, BCH, the task force designed and developed the ASN Geriatrics Nephrology Online Curriculum, with generous financial support from the Association of Specialty Professors (ASP).
This curriculum is based on the ACGME's six core competencies (patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice). The 38 chapters in this online text address the most significant aspects.
of caring for aging patients with kidney disease, including assessing GFR in the elderly, drug dosing and renal toxicity, management of ESRD in elderly patients, and end of life decision making.