Pecularities of bone disease in elderly patients with chronic kidney disease

Background: Chronic kidney disease has a high prevalence in Brazil and worldwide, being a growing public health problem that generates disabilities, early mortality and costs for health systems, causing great harm to the patient's bone health and harming metabolic and hemodynamic control and compromised quality of life. The various functions of the kidneys are influenced by the complex process of normal aging, and the progress of this process can be influenced by overlapping diseases. Microscopically, the numbers of nephrons decrease as global glomerulosclerosis becomes more evident. The precise mechanisms underlying nephron loss with aging are not well understood, but disturbances in podocyte biology appear to be. CKD classification incorporates GFR values and risk resulting from adverse events. In this way, arbitrary and fixed GFR thresholds for the definition of CKD have led to an overdiagnosis of CKD in the elderly. Objective: To discuss if an age-sensitive definition of CKD could offer a solution to this problem and capture more significantly the prognostic implications of CKD and, in particular, may be different in "healthy" aging compared to disease-induced pathology. Methods: review data on the topic in the literature and consider different points of view. Results: Although without robust studies,some of them points to exaggerated diagnoses of chronic kidney disease in the elderly and agree on the need to reassess the classification of the disease in the elderly population.Conclusions:With population aging and the increase in chronic diseases, it is essential to distinguish between physiological aging processes and diseases themselves, in order to favor more appropriate approaches and conduct.