Gemini Tanna, MD, FRCPC, Division of Nephrology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
Sarbjit Vanita Jassal, MB, BCh, MD, Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada

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Chronic kidney disease (CKD) is increasingly common among older adults. In the older individual, the presence of CKD is predictive of cardiovascular death, increased all- cause mortality, and progression to end-stage renal disease and the need for dialysis. Early identification of these high-risk individuals may prevent or delay such adverse outcomes. The Canadian Society of Nephrology (CSN) released a position statement in September 2006 suggesting that screening be limited to those at high risk. We recommend that clinicians follow the CSN algorithm for screening for CKD among older adults.
Key words: chronic kidney disease, estimated glomerular filtration rate, older adults, renal function, screening.

Michihisa Jougasaki, MD, PhD, Institute for Clinical Research, National Hospital Kyushu Cardiovascular Center, Kagoshima, Japan.

Congestive heart failure (CHF) has become an increasingly important health care issue in the older population. The prevalence of cardiovascular diseases such as hypertension, coronary artery disease and valvular heart disease increase with advancing age. In addition, age-related structural and functional changes in the cardiovascular system, such as impaired ventricular diastolic relaxation, altered energy metabolism, decreased sympathetic nervous activities and increased systemic vascular resistance, predispose older people to the development of CHF. Renal function decreases in older people, and the adequacy of renal function is important in delaying progression of CHF. Renal condition should be carefully monitored to prevent adverse effects in the treatment of CHF in older patients.

Key words: heart failure, renal function, aging, heart, kidney.

Karen Yeates MD,
Vanita Jassal MB, MSc, MD (UK)

It is well known that, with increasing age, physiologic and anatomic changes occur in the human kidney. However, in the geriatric patient it is not always easy to distinguish "normal" age associated changes from abnormalities in renal function. It is important for clinicians to recognize reduced renal function in their patient because of important implications for both its management and treatment. This review aims to answer three questions:

1. What is considered normal versus abnormal in the aged kidney?
2. How can we predict which patients are at risk of decline?
3. Who should be referred for further work up?

Anatomically, many age-related changes are believed to occur simultaneously in the kidney. Most striking is the reduction in the size of the kidney and in the number of nephrons. This decrease is reflected in the decrease in kidney size from roughly 250g at age 60, to 190g at age 80.^1,2 Age-related changes in the renal vasculature are responsible for most of the decrease in nephron mass. These changes occur independently of hypertension, and include sclerosis in the walls of larger renal vessels and further increases in the presence of hypertension.³

Functionally, there is a reduction in renal plasma flow of approximately 10% per decade, from 600ml/min in young adults, to 300ml/min by age 80 years.