Increasing economic burden caused by nephro-geriatric patients

Kim et al.¹, in their article, showed the increase in economic burden caused by kidney diseases between 2008 and 2011 in Korea. It was, at least in part, due to the aging of the population. As presented in the article, the rate of increase in the prevalence of treatment of renal diseases increases with age; in those who were above 70 years-of-age, the prevalence of treatment of renal diseases doubled in the studied period.

In fact, this phenomenon is not limited to Korea. The aging of populations is rapidly accelerating worldwide². The frequency of both chronic kidney disease (CKD)³ and acute kidney failure⁴ increases with age. Despite the fact that, due to the physiologic decrease in renal function observed with age, older adults are commonly over-diagnosed as having CKD⁵, the adjusted end-stage renal disease (ESRD) incidence rate remains much higher in patients after 65 years-of-age compared to younger age groups in the US⁶. Similarly, in Europe, approximately half of patients who start renal replacement therapy (RRT) are 65 years-old or older. Additionally, the oldest age groups on RRT are treated mainly with hemodialysis⁷, which remains the most cost-consuming method of RRT⁸. Moreover, CKD belongs to risk factors of cardiovascular diseases, and patients with CKD have a greater incidence of cardiovascular events compared to those without CKD⁹. Other co-morbidities, like, for example, malignancy, are also significant¹⁰. These factors additively increase the economic burden of this group. In effect, huge costs are generated; for example, in the US, Medicare spending for patients with CKD aged 65 and older represents 20% of all Medicare spending in this age group¹¹.

On the other hand, the incidence rate of treated ESRD in patients after 65 years-of age has been declining since the beginning of the current decade, at least in the US⁵. It may be connected to the observation that the late initiation of dialysis (i.e. at eGFR 5.0–7.0 mL/min/1.73 m²) is not inferior compared to the early initiation of dialysis (i.e. at eGFR 10.0–14.0 mL/min/1.73 m²)¹²; in that situation, some patients with typical geriatric multi-morbidity die due to extra-renal disorders before the start of RRT. Additionally, the economic burden of ESRD correlates with the duration of treatment, and the survival of older patients starting RRT is shorter compared to younger individuals¹³. Nevertheless, health systems worldwide should become prepared for a continuous increase in economic burden associated with renal diseases in the geriatric population.

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This paper was not funded.

Declaration of financial/other relationships

The author has disclosed that he has no significant relationships with, or financial interests in, any commercial companies related to this study or article. JME peer reviewers on this manuscript have no relevant financial or other relationships to disclose.