The burden of chronic kidney disease (CKD) and its risk factors are projected to rise in parallel with the rapidly ageing global population. By 2050, the prevalence of CKD category G3–G5 may exceed 10% in some regions, resulting in substantial health and economic burdens that will disproportionately affect lower-income countries. The extent to which the CKD epidemic can be mitigated depends largely on the uptake of prevention efforts to address modifiable risk factors, the implementation of cost-effective screening programmes for early detection of CKD in high-risk individuals and widespread access and affordability of new-generation kidney-protective drugs to prevent the development and delay the progression of CKD. Older patients require a multidisciplinary integrated approach to manage their multimorbidity, polypharmacy, high rates of adverse outcomes, mental health, fatigue and other age-related symptoms. In those who progress to kidney failure, comprehensive conservative management should be offered as a viable option during the shared decision-making process to collaboratively determine a treatment approach that respects the values and wishes of the patient. Interventions that maintain or improve quality of life, including pain management and palliative care services when appropriate, should also be made available.

预计慢性肾病（CKD）及其危险因素的负担将随着全球人口的迅速老龄化而增加。到 2050 年，某些地区 G3-G5 类 CKD 的患病率可能会超过 10%，从而造成巨大的健康和经济负担，对低收入国家造成不成比例的影响。 CKD 流行的缓解程度在很大程度上取决于针对可改变的风险因素采取预防措施、实施具有成本效益的筛查计划以及早发现高危人群中的 CKD，以及新药的广泛获取和可负担性。产生肾脏保护药物以预防 CKD 的发生并延缓其进展。老年患者需要采用多学科综合方法来管理他们的多发病、多用药、不良结果发生率高、心理健康、疲劳和其他与年龄相关的症状。对于进展为肾衰竭的患者，应在共同决策过程中提供全面的保守治疗作为可行的选择，以协作确定尊重患者价值观和愿望的治疗方法。还应提供维持或改善生活质量的干预措施，包括适当时的疼痛管理和姑息治疗服务。