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Doubts cast over treating CKD in elderly

GPs face having to treat more than half of all their elderly patients for chronic kidney disease, despite serious questions over the evidence for benefit.

As many as 56% of people aged 75 or over have an eGFR of 60 or below, indicating stage 3 to 5 CKD, a study of 53 GP practices has found.

But the researchers, who presented their data at the Renal Association conference in Brighton this week, warned the benefits for treating older patients with an eGFR of over 45 'need to be determined'.

A second study found almost all nursing home residents had clinically measurable kidney disease.

Researchers sampled 6.6% of the population of 155 east Kent nursing homes and found that using the Cockcroft-Gault equation 97% had CKD at stage 3 or worse. Using the MDRD equation more generally in service gave a still massive prevalence of 82%.

Study leader Dr Edmund Lamb, consultant clinical scientist at East Kent Hospitals and renal expert for the Association for Clinical Biochemistry, said: 'The prevalence of CKD in this population appears to far exceed that in the non-institutionalised population and CKD is generally unrecognised. This may have important implications for management of the population – for example, treatment with renally excreted drugs.'

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