We therefore cannot draw much direct evidence from these RCTs to indicate how to properly manage BP in elderly CKD patients, although some inferences might be drawn from BP studies in elderly populations not specifically chosen for the presence of CKD. Measurement of BP in the elderly. Assessment of BP in the elderly is made more difficult by such common issues as the presence of atrial fibrillation (as seen in 25% of patients Z 70 years in the Chronic Renal Insufficiency Cohort (CRIC) ), orthostatic hypotension44,45 and the tendency for pulse pressure to widen with arterial stiffening, resulting in The literature on management of elderly patients has thus been focused more on systolic than diastolic BP. There is relevant observational evidence from the SHEP study.374 In an analysis of 2181 persons 465 years of age in the placebo arm of this study, systolic BP was more predictive of decline in kidney function (i.e., rise in SCr by Z0.4 mg/dl [35.4 mmol/l] over 5 years) than diastolic BP, pulse pressure, or MAP. The mean age was 72 years and patients with renal http://www.kidney-international.org chapter 7 & 2012 KDIGO failure were excluded. Among those enrolled, the initial SCr level was 1.04 0.23 mg/dl (92 20 mmol/l). Hence, most subjects probably had normal kidney function or CKD stages 1 3. CKD in the elderly. 