Diabetic renal disease in older people

As the population ages and the prevalence of diabetes increases, more and more older people will suffer from diabetic complications, including renal disease. There are very few studies of older diabetic people with renal disease and most of our knowledge and treatment base are derived from information generated in younger patients. In older people, blockade of the renin‐angiotensin system seems to be as important as it is in younger people; however, these drugs are often prescribed at suboptimal doses. Further, while glycaemic and blood pressure control is paramount, factors such as cognitive impairment and postural hypotension can make the management of these aspects difficult in older people. Cardiovascular disease is very common in people with chronic renal disease, and thus older people are also likely to benefit from cardiovascular risk factor protection. Estimating renal function in older people can also be less reliable due to reduced muscle mass and less well validated measures of renal function. However, when end‐stage renal disease is established, many treatment options, including renal replacement therapy, are well tolerated and are being increasingly used in older people. This article discusses the evidence and treatments available for older people with diabetic renal disease.