There is a lack of consensus about how early chronic kidney disease (CKD) should be diagnosed and managed in older people. Some believe that reduced renal function in older age is usually benign and that identifying it as a condition requiring medical intervention is inappropriate, whereas others believe it represents an important public health issue. This uncertainty is not reflected in management guidelines.

There is no controversy, however, that advanced CKD is particularly dangerous in older people. They are at risk of acute kidney injury, often worsened by unenlightened medical management. As CKD advances towards end stage in older people, treatment choices are even more difficult to make and there is a need for insightful input from carers to optimise outcomes.