Send us a text

The For Kidneys Sake podcast series is brought to you by Imperial College Healthcare NHS Trust and North West London Integrated Care Board (NWL NHS).

In this episode of For Kidneys Sake, consultants Prof Jeremy Levy and Dr Andrew Frankel are joined by Dr Melanie Dani, a geriatrician, to discuss the complexities of managing chronic kidney disease (CKD) in older adults. They highlight the importance of distinguishing between chronological age and frailty, two overlapping but distinct concepts that significantly influence clinical decision-making. The conversation explores how kidney function naturally declines with age, and raises the critical question of when this becomes a pathological concern requiring medical intervention.

Dr Dani stresses the value of personalised care, reminding listeners that older adults are not a homogenous group. Whether someone is a fit 85-year-old playing tennis or a frail resident in a care home, their values, priorities and tolerance for medical treatment will differ. The episode encourages shared decision-making, consideration of overall health context, and careful use of medications like ACE inhibitors and SGLT2 inhibitors based on likely benefits and side effects, rather than age alone.

Three Key Takeaways

1. Ageing vs Frailty: Frailty is a better predictor of health outcomes than age alone. It’s essential to assess a patient’s overall vulnerability and resilience when managing CKD.
2. Reduced GFR in Older Adults: A declining GFR may reflect normal ageing rather than disease, but it still carries risks, particularly cardiovascular. Management should be tailored to the individual, not solely guided by guidelines.
3. Personalised, Contextualised Care: Decisions about referral, investigation and treatment must consider the whole person—their wishes, comorbidities, and quality of life—rather than focusing only on kidney function metrics.

Resource Links:
NICE GUIDELINES [NG203] chronic kidney disease: assessment and management Overview | Chronic kidney disease: assessment and management | Guidance | NICE

Northwest London CKD guidelines for primary care Chronic kidney disease (nwlondonicb.nhs.uk)

The purpose of this podcast is to inform and educate health care professionals working in the primary care and community setting. The content is evidence based and consistent with NICE guidelines and North West Guidelines available at the time of publication.

The content of this podcast does not constitute medical advice and it is not intended to function as a substitute for a healthcare practitioner’s judgement.

Produced by award-winning media and marketing specialist Heather Pownall of Heather's Media Hub