HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) All Versions of this Article: CJN.00410108v1 3/4/1185    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Abaterusso, C. Articles by Gambaro, G. Search for Related Content PubMed PubMed Citation Articles by Abaterusso, C. Articles by Gambaro, G.

Treating Elderly People with Diabetes and Stages 3 and 4 Chronic Kidney Disease

Cataldo Abaterusso^*, Antonio Lupo^*, Vittorio Ortalda^*, Vincenzo De Biase^*, Antonello Pani, Michele Muggeo, and Giovanni Gambaro^*

^* Nephrology; Endocrinology, Department of Biomedical and Surgical Sciences, University Hospital of Verona, Verona; and Division of Nephrology, "Brotzu" Hospital, Cagliari, Italy

Correspondence: Prof. Giovanni Gambaro, Divisione di Nefrologia, Dipartimento di Scienze Biomediche e Chirurgiche, Università di Verona, Ospedale Maggiore, P.le Stefani 1, 37126 Verona, Italy. Phone: +39-045-8122521; Fax: +39-045-915176; E-mail giovanni.gambaro{at}univr.it

Dedicated European and US clinical guidelines for type 2 diabetes in the elderly have been released, but they do not specifically address the issue of advanced chronic kidney disease (CKD) in older patients with diabetes. General clinical guidelines have been published on the treatment of patients with diabetic nephropathy (DN), but these address the issue of how to prevent progression and treat advanced DN without distinguishing between different age groups. Elderly patients with diabetes and stages 3 to 4 CKD have particular needs that differ from those of younger patients with the same conditions. This is mainly due to their frailty and shorter life expectancy. Differently tailored therapeutic strategies are needed, which may have less stringent targets; and the use of common drugs should be critically evaluated. The management agenda (metabolic control, low-protein diet, controlling BP, preventing progression of advanced DN, preventing cardiovascular outcomes) for these patients is discussed in light of the limits and perspectives of current guidelines. Intensive, simultaneous management of all items on the agenda may not be feasible for a proportion of older patients, and clinicians may have to give priority to reducing some risk factors rather than others, choosing between different therapies.