Kim et al.Citation1, 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 worldwideCitation2. The frequency of both chronic kidney disease (CKD)Citation3 and acute kidney failureCitation4 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 CKDCitation5, 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 USCitation6. 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 hemodialysisCitation7, which remains the most cost-consuming method of RRTCitation8. Moreover, CKD belongs to risk factors of cardiovascular diseases, and patients with CKD have a greater incidence of cardiovascular events compared to those without CKDCitation9. Other co-morbidities, like, for example, malignancy, are also significantCitation10. 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 groupCitation11.
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 USCitation5. 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)Citation12; 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 individualsCitation13. 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.
References
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- World Health Organization. World report on ageing and health. WHO; Geneva. 2015. http://apps.who.int/iris/bitstream/10665/186463/1/9789240694811_eng.pdf?ua=1
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- Małyszko J, Kozlowski L, Kozłowska K, et al. Cancer and the kidney: dangereoux liasons or price paid for the progress in medicine? Oncotarget 2017;8:66601-19
- United States Renal Data System. 2016 USRDS annual data report: Epidemiology of kidney disease in the United States. Volume 1, Chapter 6: Medicare Expenditures for Persons with CKD. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; Bethesda, MD. 2016. https://www.usrds.org/2016/view/v1_06.aspx
- Cooper BA, Branley P, Bulfone L, et al. A randomized, controlled trial of early versus late initiation of dialysis. N Engl J Med 2010;363:609-19
- United States Renal Data System. 2016 USRDS annual data report: Epidemiology of kidney disease in the United States. Volume 2, Chapter 6: Mortality. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; Bethesda, MD. 2016. https://www.usrds.org/2016/viev/v2_06.aspx