An approach to treating older adults with chronic kidney disease

group to start dialysis.1 In Canada, more than half of patients • The management of risk factors for CKD should be starting dialysis are 65 years or older.2 Chronic kidney disease individualized with consideration of less aggressive targets for confers considerable morbidity on patients and consumes a frail patients at risk of polypharmacy. [...] substantial amount of health care resources.1 Few evidence- • The Kidney Failure Risk Equation is a useful tool in the based guidelines specifically speak to management of CKD in evaluation of and ongoing treatment for CKD for both general practitioners and nephrologists. [...] Hypertension Canada risk of hypermagnesemia.27 Newer agents such as secretagogues (2020) recommends a target BP goal of less than 130/80 in (linaclotide and lubiprostone) are less commonly used but are safe patients with CKD and diabetes mellitus, and less than 120/80 in and effective in CKD and may help excrete phosphate as well.27 patients with CKD without diabetes mellitus, irrespective of Stra. [...] CMAJ | May 1, 2023 | Volume 195 | Issue 17 E615 Review Although dialysis may provide increased survival and symptom and high degree of frailty.43 The focus is on managing symptoms relief, the benefit is modest in older and frail patients, and dialysis and avoiding invasive or uncomfortable therapies that offer min- can be associated with considerable reduction in independence imal benefit in survi. [...] Contributors: Both authors contributed to the conception and design of the work, drafted the manuscript, revised it critically for important intellectual content, gave final approval of the version to be published and agreed to be accountable for all aspects of the work.