This systematic review would suggest that midodrine has a role in the therapy of haemodialysis patients experiencing IDH. This conclusion must be viewed with caution, however, given the quality and sample size of the studies included in this review.

Referral to a nephrologist before initiation of chronic dialysis occurs less frequently for blacks than whites, but the reasons for this disparity are incompletely understood. Here, we examined the contribution of racial composition by zip code on access and quality of nephrology care before initiation of renal replacement therapy (RRT). We retrospectively studied a cohort study of 92,000 white and black adults who initiated RRT in the United States between June 1, 2005, and October 5, 2006. The percentage of patients without pre-ESRD nephrology care ranged from 30% among those who lived in zip codes with Ͻ5% black residents to 41% among those who lived in areas with Ͼ50% black residents. In adjusted analyses, as the percentage of blacks in residential areas increased, the likelihood of not receiving pre-ESRD nephrology care increased. Among patients who received nephrology care, the quality of care (timing of care and proportion of patients who received a pre-emptive renal transplant, who initiated therapy with peritoneal dialysis, or who had a permanent hemodialysis access) did not differ by the racial composition of their residential area. In conclusion, racial composition of residential areas associates with access to nephrology care but not with quality of the nephrology care received.

Keywordschronic kidney disease; elderly; management strategies; outcomes Our goals in this review are to describe what is known about the prevalence and clinical implications of non-dialysis dependent chronic kidney disease (CKD) in the elderly and to discuss some of the most common challenges to managing older patients with CKD. Prevalence of CKD in the elderlyThe prevalence of CKD rises dramatically with age. Based on the results of the National Health and Nutrition Examination Survey 1999-2004 (NHANES), more than one third of those aged 70 or older have moderate or severe CKD defined as an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m 2 [1,2]. While all stages of CKD are more common at older ages (including earlier stages of CKD, defined as albuminuria with a preserved eGFR), it is the prevalence of moderate CKD (eGFR 30-59 ml/min/1.73 m 2 ) that increases most dramatically with advancing age (Figure 1).The high prevalence of CKD in the elderly no doubt reflects the presence of a variety of different risk factors for CKD such as diabetes and hypertension in older individuals. However, high rates of CKD in the elderly may also occur because of an age-associated decline in kidney function that is not explained by other known risk factors. Relatively little is known about how renal function changes during the course of "normal" aging. The Baltimore Longitudinal Study of Aging (BLSA) measured change in creatinine clearance over time among a subset of participants without kidney disease or other known comorbidities [3]. Among these participants, creatinine clearance declined on average by 0.75 ml/min/year. However, among some participants in this study, renal function did not decline at all. Results from BLSA thus suggest that on average kidney function tends to decline with aging even among those without comorbidity, but that this decline does not appear to be inevitable.Regardless of the reason(s) for the high prevalence of CKD in the elderly, it is clear that as the population ages we can expect to see a large expansion in the number of older individuals who meet current criteria for CKD. For example, in 2000, there were approximately 25 million adults 70 years or older, accounting for 9% of the population. By the year 2050, based on US

SummaryBackground and objectives The objective of this study was to evaluate the association between neighborhood socioeconomic status and barriers to peritoneal dialysis eligibility and choice.