Kidney Failure in the Elderly
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What is Kidney Failure in Older Adults?

The human body constantly completes countless biological processes to keep itself functioning. While some life activities, like breathing, are readily apparent, other body systems operate without being noticed. The chemical reactions needed to nourish our cells create organic waste that is harmful to the body.

The kidneys are the central organs of the renal system and function imperceptibly until there is a significant health issue. They remove toxins and organic waste from the cells and release them from the body in urine. Natural age-related changes reduce kidney function, just like every other organ. As adults age, they often develop chronic kidney disease or experience kidney failure, in which renal system function slows and eventually ceases, disabling the body from purifying the blood.

According to the CDC, 38% of U.S. adults over 65 have chronic kidney disease. Exacerbating the problem, researchers estimate as many as 9 in 10 adults are unaware they suffer from the condition. It’s critical for older adults and their caregivers to understand the risk factors, signs, and preventative steps for kidney failure.

What is Kidney Failure in Older Adults?

Kidney failure, also called end-stage kidney disease, occurs when kidney disease reaches its advanced stage. Once an elderly person enters kidney failure, their body can no longer filter waste material on its own. The only way to stay alive is with kidney dialysis, a medical treatment that filters the blood, or a kidney transplant.

In order to have a better understanding of the condition, let’s look at other common kidney problems:

What are the Differences? Kidney Infection vs. Kidney Disease vs. Poor Kidney Function vs. Kidney Decline

Kidney Infection

A kidney infection is an acute illness affecting one or both kidneys. The most common type of kidney infection results from an untreated UTI, which progresses through the unitary tract, reaching the kidneys. Infections are serious illnesses that leave older adults susceptible to sepsis or systemic blood infections. Untreated kidney infections can be life-threatening.

Infections can also attack the anatomical structures within the kidney that filter the blood. This damage can lead to acute renal failure, a rapidly progressing fatal condition.

Kidney Disease

Kidney disease, sometimes referred to as chronic kidney failure, is a long-term medical condition in which an individual’s kidney function diminishes. As the disease progresses, older people experience an unsafe build-up of fluids, electrolytes, and wastes in the body. Doctors treat kidney disease by working to minimize the ongoing damage that harms the kidneys. Many older adults fail to detect their kidney disease in its early stages, allowing their renal function to continue falling until it reaches dangerous levels.

Poor Kidney Function

Renal insufficiency is a condition in which the kidneys function poorly, possibly because of poor circulation due to renal artery disease. This condition occurs when the blood vessels that nourish the kidneys narrow, depriving them of blood. The lack of circulation diminishes the kidneys’ ability to filter waste products.

Kidney Decline

Kidney decline is a term used to describe changes in the kidney’s ability to function. As the organ loses its ability to remove organic waste from the blood, its declining function allows toxins to accumulate in the body. The signs of kidney decline can be undetectable until renal function is 20% or less than the normal level.

What are the Signs of Kidney Failure in Older Adults?

What are the Signs of Kidney Failure in the Elderly

The signs of kidney failure for older adults can be subtle until their end-stage. It’s important to monitor yourself or loved ones for changes to overall health, a loss of well-being, and the following signs to detect chronic kidney disease and failure before it becomes untreatable.

  • Fatigue and Malaise: As kidney function declines, the harmful waste building up in an older adult’s system can cause them to feel tired, weak, and rundown. Chronic kidney disease can also lower red blood cell levels, leading to anemia.
  • Swollen Feet and Ankles: Renal failure may elevate sodium levels and cause fluid retention, leading to swelling in the lower extremities. This can also signal heart disease or poor vascular function. The elderly should always consult their doctor about their foot and ankle swelling.
  • Uncontrollable High Blood Pressure: Beyond their primary role as a filter for waste, the kidneys also produce hormones that help regulate blood pressure. Older adults with kidney disease may have hypertension that is hard to manage using medications.
  • Increased Need to Urinate: Damage to the kidneys’ filters may increase an older adult’s need to urinate, especially overnight. This sign can be easily dismissed as an inevitability of aging or a symptom of a UTI.
  • Changes to the Urine: Renal failure alters how the kidneys function, leading to visible changes in the urine. Some elderly people will have blood in the urine because blood cells escape through the filters into the urine. Others will have high protein content in their urine, leading to excessively “foamy” urine.
  • Decreased Output: As kidney function diminishes and waste accumulates in the body, older adults may produce less urine despite consistent fluid intake. The elderly should monitor how often they use the bathroom and consider their level of output relative to how much they are drinking.
  • Shortness of Breath: As fluid build-up occurs due to kidney dysfunction, some of the retained liquid may accumulate in the lungs. This fluid leads to shortness of breath, a serious symptom that must be treated immediately.
  • Confusion: In some cases, older adults with renal failure may become disoriented, forgetful, or confused. They may dismiss this symptom themselves, or their caregivers may consider it a sign of a broader cognitive issue.

What are the Stages of Kidney Failure in Older Adults?

What are the Stages of Kidney Failure in Older Adults

Doctors use diagnostic testing to determine the progression of an older adult’s chronic kidney disease based on the level of renal damage. The elderly should never try and self-diagnose their kidney problems. They should consult a doctor if they believe they have signs or symptoms of kidney disease.

The staging relies on an estimated glomerular filtration rate (eGFR) test. Doctors measure the level of kidney function based on bloodwork readings and assign a rating based on the level.

  • Stage 1 Kidney Disease: In this stage, the eGFR is above 90, a normal reading, but the patient exhibits slight signs and symptoms, such as protein in the urine. Kidney damage is mild.
  • Stage 2 Kidney Disease: The eGFR score is 60 to 89. The damage is mild. While the kidneys function well, they are below normal levels. Physical symptoms are often absent.
  • Stage 3A Kidney Disease: Patients have an eGFR between 45 and 59. The kidneys’ dysfunction allows fluid to begin building up in the body. Damage is considered mild to moderate. Patients begin exhibiting other symptoms of kidney disease, including fatigue.
  • Stage 3B Kidney Disease: The eGFR is 30 to 44. At this stage, kidney function is below normal because the damage is moderate to severe. The continued build-up of waste may cause other health problems like high blood pressure or loss of bone density. Many older adults can halt the progression of their kidney disease in stage 3 with proper treatment and lifestyle modifications.
  • Stage 4 Kidney Disease: Older adults in stage 4 have an eGFR between 15 and 29. Renal damage is severe and kidney function is significantly diminished. In many cases, patients experience lower extremity swelling and pain in the back. Older adults in this stage must be under the supervised care of a renal specialist.
  • Stage 5 Kidney Disease: This is late-stage kidney disease or renal failure. The eGFR is below 15, meaning the kidneys are barely functioning or have completely shut down. Stage 5 kidney disease is fatal without routine dialysis or kidney transplant.

What Causes Kidney Failure in Older Adults?

What Causes Kidney Failure in the Elderly

While natural cell breakdown and the slowdown of bodily processes contribute to kidney disease, many controllable factors can damage the kidneys, leading to renal failure in older adults. Causes include:

  • Diabetes: Excess glucose in the blood resulting from diabetes damages the filters within the kidneys, leading to renal failure. This damage often presents with elevated protein levels in the urine.
  • Hypertension: The kidneys and circulatory system are linked. High blood pressure can restrict circulation to the kidneys, limiting their functional ability. Compounding the problem, kidney dysfunction further elevates blood pressure.
  • Poor Diet: Eating processed foods and a diet high in salt may harm the kidneys. Processed foods are often high in phosphorous, which taxes the kidneys. High salt consumption can elevate blood pressure.
  • Poor Fluid Intake: Not drinking enough water can allow toxins and waste to accumulate in the kidneys, affecting their ability to filter and function.
  • Smoking and Drinking: Smoking and alcohol harm the blood vessels, hindering circulation which may contribute to kidney disease.
  • Sedentary Lifestyle: Lack of movement and regular exercise compromises heart health and depresses kidney function, leading to renal damage. Consistent physical activity also regulates blood glucose levels.

Managing Kidney Failure

Investigators estimate that more than half of all adults over 75 have kidney disease. With early detection and treatment, many older adults can live and function normally. Older adults with heart failure or kidney failure are at elevated risk of developing the other condition based on the connections between circulatory and renal function. In many cases, managing one can improve the other. Treatment is based on the stage of kidney disease and the patient’s comorbidities. Options include:

  • Lifestyle Modifications: Doctors may recommend a low-sodium diet, increased fruit and vegetable intake, or eliminating processed foods to protect the kidneys and lower blood pressure.
  • Medication: In many cases, treating hypertension and regulating glucose levels can help manage chronic kidney disease and preserve function, stopping its progression in stage 3 or 3B. Doctors may also prescribe diuretic medication to help patients remove excess fluid from their bodies.
  • Dialysis: Older patients whose chronic kidney disease reaches stage 5 need dialysis treatments. During this outpatient procedure, a machine is used to filter the blood in place of the kidneys. Older adults must adhere to a consistent dialysis schedule and abide by doctor-recommended lifestyle changes to maximize the effectiveness of the treatment.

Preventing Kidney Failure in Older Adults

How to Prevent Kidney Failure in the Elderly

Chronic kidney disease is a common challenge that most older adults will face during their lifetime. While some individuals are genetically predisposed to chronic kidney disease or suffer acute infections leading to renal failure, preventative steps may slow chronic kidney disease and avert renal failure. Older adults and their caregivers should:

  • Stay Vigilant: In many cases, the early signs of kidney disease are undetectable or easy to overlook. Older adults should monitor for subtle changes in urination, fatigue, lower extremity swelling, and cognitive changes. Attending annual physical exams with primary care providers and receiving routine bloodwork can detect kidney disease in its earliest stages.
  • Control Blood Pressure: Older adults should take prescribed hypertension medication as directed to control blood pressure. Eating a low sodium diet, managing stress, and remaining physically active can help control blood pressure levels.
  • Maintain Weight: Obesity is a risk factor for both diabetes and kidney disease. Maintaining a healthy weight lowers stress on the body and regulates glucose levels to guard the kidneys against damage.

How Can Caregivers Help a Senior Loved One with Kidney Failure?

Early detection and compliance are vital for preventing and managing kidney disease and failure. Caregivers should:

  • Encourage and Educate: Caregivers should make sure their loved one understands the risks and prevalence of kidney disease. Encourage loved ones to attend annual doctor’s appointments and remind them to discuss changes in their urination, pain level, and general well-being.
  • Compliance: Caregivers should ensure older adults are picking up prescriptions and taking blood pressure, diabetes, and cholesterol medication as directed. If a loved one is in end-stage renal failure, confirm they are attending dialysis appointments by arranging transportation and compliance with post-treatment instructions.

What is the Life Expectancy for Older Adults with Kidney Failure?

Kidney failure or chronic kidney disease is a long-term condition whose life expectancy depends on the stage of disease, patient’s overall health, and lifestyle. While kidney damage can be slowed in its early stages, the kidneys cannot be repaired and regain function. However, with proper management that stops the progression of kidney damage in stage 3, older adults can live full lives.

In general, older adults with Stage 5 kidney disease or end-stage kidney failure can live 5 to 10 years with dialysis.

Life expectancy for patients who undergo a kidney transplant is 10 to 20 years. The surgery is considered relatively safe and older adults are viable candidates for transplants.

If a patient with end-stage kidney failure chooses medical management, doctors focus on treating the symptoms and making them comfortable. Although the condition is fatal, it’s difficult to predict an exact life expectancy.


1. The DASH Diet – National Kidney Foundation

2. Aging and Kidney Disease – National Kidney Foundation

3. 10 Common Habits That May Harm Your Kidneys – National Kidney Foundation

4. Causes of Chronic Kidney Disease – National Institute of Diabetes and Digestive and Kidney Diseases

5. DiagnosisChronic kidney disease

6. Older Adults with Kidney Disease – University of Michigan Health

7. 10 Signs You May Have Kidney Disease – National Kidney Foundation

8. What is Kidney (Renal) Failure? – Urology Care Foundation

9. Renal insufficiency – UC Davis Health


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