Dr. Jenna Henderson, ND

Subheadline 

A clinical overview of kidney function changes with aging, common diagnostic pitfalls, and natural approaches to support renal health in older adults.

Short Description 

This article examines the natural decline in kidney function with aging, emphasizing key considerations in interpreting eGFR, creatinine, and related biomarkers in older adults. It outlines integrative strategies—including nutrition, supplementation, lifestyle, and medication awareness—to support renal health and slow functional decline.

Introduction

Declining kidney function is a common feature of aging.  Often, the elderly are unaware of any kidney stress.  Conventional approaches often involve blood pressure medication and telling the patient that dialysis may be in their future.  Fortunately, there are natural approaches to kidney health that can support function in the elderly population.  

1. Estimated glomerular filtration rate (eGFR) is calculated with age. People generally take eGFR to be what out of 100% the kidneys are functioning. eGFR is a derived number that comes from plugging three values into a mathematical equation.  These values are age, creatinine, and gender.

A 30-year-old male with a creatinine of 1.1 mg/dL would have an eGFR of 93.  However, an 80-year-old male with the same creatinine would have an eGFR of 68.  

2. Dehydration can throw off results of a blood test. Creatinine is used to calculate kidney function, and this waste product is measured for a specific volume unit of blood.  If the patient is dehydrated, the creatinine will be more concentrated.¹

Proper hydration in the elderly can be a challenge. As the sense of thirst diminishes with age, many older adults are resistant to drinking more water. There are also patients with congestive heart failure who limit fluid to avoid fluid overload.  

3. Sarcopenia should be considered when considering kidney health in the elderly. Creatinine is a breakdown product that comes from muscle tissue. Using Cystatin-C to calculate eGFR, can be useful, as the waste product Cystatin-C does not come from muscle tissue.²

A frail, elderly woman with sarcopenia would be expected to have a lower creatinine, than a healthy younger person.  Seeing a creatinine above 1.3 would be more concerning in an elderly person with sarcopenia, than with a younger person with more muscle mass.  A blood test can be run with Cystatin-C to determine if sarcopenia is playing a role.²

4. Over-corrected blood pressure can alter the results of a kidney function test. The kidneys filter the blood across a pressure gradient.  To illustrate this point to patients, it can be likened to squeezing a sponge while cleaning.  If kidney filtration is low, the kidneys adapt by increasing the pressure gradient to maintain filtration.  This is not necessarily a good adaptation, as when a sponge is squeezed very hard over time, the sponge itself starts to wear down.  Hypertension can cause irreparable damage to the small blood vessels inside the kidney.  

When out of control blood pressure is corrected, many of these patients will see their creatinine go up.  Often, they erroneously believe that the blood pressure medication was toxic to their kidneys and may even stop taking it.  However, it was not the case that the medications were nephrotoxic, but they revealed how much damage had already taken place.  A healthy kidney doesn’t need to raise blood pressure to maintain filtration.  

If blood pressure is corrected to well below 120/80, the creatinine will go up as there is not enough internal tension for adequate filtration.³ These patients may experience lethargy or postural hypotension with a “head rush” feeling when they stand up suddenly.  As the blood vessels are less elastic in the elderly, it may take more force to pump blood from the heart to the top of the head.⁴  

5. There may be no other explanation for low kidney function in the elderly other than age related decline.  There may be newly diagnosed diabetes in the elderly, but long-standing diabetes, even well-controlled, can have a cumulative effect on the kidneys over time.  Hypertension is often newly diagnosed in the elderly, and anything before age 55 is considered early onset.⁵

The most common causes of nephrotic syndrome in the elderly are membranous glomerulonephritis, amyloidosis and diabetic nephropathy.⁶ Autosomal dominant polycystic kidney disease is a genetic condition, but patients may not start to notice symptoms until age 30 or 50.⁷ 

If other conditions are ruled out, the patient over age 65 may simply be experiencing age related kidney decline.  Stenosis of the renal arteries may be a factor in this decline.⁸

6. The antioxidant Klotho, which is produced in the kidneys, plays a role in both kidney disease and aging. According to Traditional Chinese Medicine, the kidneys house the jing, an inherited vital force that governs growth, maturation and aging.  Discovered in 1997, the molecule of Klotho, sounds very similar to the TCM description of jing.⁹ Klotho levels are low not only with chronic kidney disease, but also correlate with diseases of aging.  

Botanical medicines that enhance Klotho include Salvia miltiorrhiza¹⁰, Korean red ginseng¹¹, curcumin¹², Fo-ti¹³, green tea¹⁴, and cordyceps mushroom¹⁵. 

7. Medications often play a role in kidney decline in the elderly. Seniors who do not take any medications are rare. NSAIDs and PPI medications are common culprits creating kidney stress.  Also concerning are some antibiotics, contrast dye and laxatives.¹⁶
8. Key antioxidants/nutrients that decline with age can help support the kidneys.  

1. • Coenzyme Q10, which declines with age, directly supports kidney function.¹⁷  
   • L-carnitine: Many conditions of aging are improved with this amino acid. As l-carnitine mostly comes from animal products, those with a plant-based diet have lower circulating levels.¹⁸  L-carnitine levels are maintained by renal resorption, and excess l-carnitine is promptly excreted.¹⁹ Diabetic podocyte injury is ameliorated by l-carnitine.¹⁹ 
   • Magnesium levels often decline with age due to poor intake, lesser intestinal absorption, and renal wasting.²⁰ Optimal levels of magnesium are important as low levels of magnesium are associated with a faster decline of kidney function.²¹
   • Melatonin, an endogenous antioxidant that decreases with age, can support kidney function.²²  
   • Vitamin D levels are often low in elderly.  Being housebound can be a factor, but also there is less synthesis of D in the skin of the elderly.²³  

9. Mild exercise is helpful for the kidneys. In most cases, exercise improves kidney health.  Structured moderate exercise in older adults was found to improve eGFR in sedentary adults after 2 years of physical activity.²⁴ Better physical performance is associated with better clinical outcomes in chronic kidney disease.²⁵
10. Depression is important to address in the elderly as it is associated with kidney disease.

There is a strong association between a rapid decline of kidney function and depressive symptoms.²⁶ A 4-year study from China found depression was linked to several chronic diseases, but the association with kidney disease was the most statistically significant.²⁷

Compounded personal losses and increasing dependence put the elderly at risk for depression.  The depressed patient is also less likely to seek out necessary health care.28 Addressing mental health concerns can be an important part of a holistic approach for the elderly patient with kidney issues.

References:

1. National Kidney Foundation website.  Can dehydration cause creatinine to rise? If so, by what factor? Available at:  https://www.kidney.org/blog/ask-doctor/can-dehydration-cause-creatinine-rise-if-so-what-factor Accessed March 12, 2026.  
2. Bargnoux A, Barguil Y, Cavalier E, Cristol J. [Estimation of glomerular filtration rate using cystatin C]. Review Ann Biol Clin (Paris). 2019 Aug 1;77(4):375-380.
3. Chen D, McCallum W, Sarnak M, Ku E. Intensive BP Control and eGFR Declines: Are These Events Due to Hemodynamic Effects and Are Changes Reversible? Curr Cardiol Rep. 2020 Aug 9;22(10):117.
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6. Li M, Cai G. Diagnosis and Treatment of Nephrotic Syndrome in the Elderly. Journal of Integrative Neprology & Andrology. 2015:2(4):123-127.
7. National Institute of Diabetes and Digestive and Kidney Diseases website.  Autosomal Dominant Polycystic Kidney Disease. Available at:  https://www.niddk.nih.gov/health-information/kidney-disease/polycystic-kidney-disease/autosomal-dominant-pkd.  Accessed March 11, 2026.
8. Battaglia Y, Fiorini F, Gisonni P, Imbriaco M, Lentini P, Zeiler M, Russo L, Prencipe M, Russo D. Ultrasonographic Assessment of Atherosclerotic Renal Artery Stenosis in Elderly Patients with Chronic Kidney Disease: An Italian Cohort Study. Diagnostics (Basel). 2022 Jun 13;12(6):1454.
9. Sosnowski B, Bachórzewska-Gajewska H, Dobrzycki S, Malyszko J.  [Klotho not only antiageing protein]. Przegl Lek. 2017;74(1):25-9. 
10. Xu Q, Li H, Zhang X, Ding H, Cao J.  Tanshinone IIA elevates serum soluble klotho levels and decreases cardiovascular events in patients on maintenance hemodialysis: a prospective before-after study. Ann Palliat Med. 2020 Jul;9(4):2131-2140.
11. Lim S, Shin Y, Luo K, Quan Y, Cui S, Ko E, Chung B, Yang C.  Ginseng increases Klotho expression by FoxO3-mediated manganese superoxide dismutase in a mouse model of tacrolimus-induced renal injury. Aging. 2019 Aug 10;11(15):5548-5569.
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13. Zhou X, Yang Q, Xie Y, Sun J, Hu J, Qiu P, Cao W, Wang S.  Tetrahydroxystilbene glucoside extends mouse life span via upregulating neural klotho and downregulating neural insulin or insulin-like growth factor 1. Neurobiol Aging. 2015 Mar;36(3):1462-70.
14. Kim H, Chang H, Han S, Lee M, Jung J, An S, Baek S, Lee J, Lee J, Lee T, Shin D, Kim H.  Epigallocatechin-3-O-(3-O-methyl)-gallate-induced differentiation of human keratinocytes involves klotho-mediated regulation of protein kinase-cAMP responsive element-binding protein signaling. Int J Mol Sci. 2014 Apr 4;15(4):5749-61.
15. Tang R, Zhou Q, Shu J, Tang T, Ao X, Peng W, Zhang Y.  [Effect of cordyceps sinensis extract on Klotho expression and apoptosis in renal tubular epithelial cells induced by angiotensin II]. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2009 Apr;34(4):300-7.
16. Taber S, Mueller B. Drug-associated renal dysfunction. Crit Care Clin. 2006 Apr;22(2):357-74.
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18. Dahash B, Sankararaman S. Carnitine Deficiency. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan.
19. Ito S, Nakashima M, Ishikiriyama T, Nakashima H, Yamagata A, Imakiire T, Kinoshita M, Seki S, Kumagai H, Oshima N.  Effects of L-Carnitine Treatment on Kidney Mitochondria and Macrophages in Mice with Diabetic Nephropathy. Kidney Blood Press Res. 2022;47(4):277-290.
20. Barbagallo M, Veronese N, Dominguez L. Magnesium in Aging, Health and Diseases. Nutrients. 2021 Jan 30;13(2):463.
21. Ferrè S, Li X, Adams-Huet B, Maalouf N, Sakhaee K, Toto R, Moe O, Neyra J.  Low serum magnesium is associated with faster decline in kidney function: the Dallas Heart Study experience. J Investig Med. 2019 Aug;67(6):987-994.
22. Quiroz Y, Ferrebuz A, Romero F, Vaziri N, Rodriguez-Iturbe B. Melatonin ameliorates oxidative stress, inflammation, proteinuria, and progression of renal damage in rats with renal mass reduction.  Am J Physiol Renal Physiol. 2008 Feb;294(2):F336-44.
23. Nowak J, Hudzik B, Jagielski P, Kulik-Kupka K, Danikiewicz A, Zubelewicz-Szkodzińska B. Lack of Seasonal Variations in Vitamin D Concentrations among Hospitalized Elderly Patients.  Int J Environ Res Public Health. 2021 Feb 9;18(4):1676.
24. Shlipak M, Sheshadri A, Hsu F, Chen S, Jotwani V, Tranah G, Fielding R, Liu C, Ix J, Coca S. Effect of Structured, Moderate Exercise on Kidney Function Decline in Sedentary Older Adults: An Ancillary Analysis of the LIFE Study Randomized Clinical Trial.  JAMA Intern Med. 2022 Jun 1;182(6):650-659.
25. Roshanravan B, Robinson-Cohen C, Patel K, Ayers E, Littman A, de Boer I,  Ikizler T, Himmelfarb J, Katzel L,  Kestenbaum B, Seliger S. Association between physical performance and all-cause mortality in CKD.  J Am Soc Nephrol. 2013 Apr;24(5):822-30.
26. Zhang Z, He P, Liu M, Zhou C, Liu C, Li H, Zhang Y, Li Q, Ye Z, Wu Q, Wang G, Liang M, Qin X. Association of Depressive Symptoms with Rapid Kidney Function Decline in Adults with Normal Kidney Function.  Clin J Am Soc Nephrol. 2021 Jun;16(6):889-897.
27. Bi Y, Pei J, Hao C, Yao W, Wang H. The relationship between chronic diseases and depression in middle-aged and older adults: A 4-year follow-up study from the China Health and Retirement Longitudinal Study.  J Affect Disord. 2021 Jun 15;289:160-166.
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Author Bio:  

Dr. Jenna Henderson, ND is the founder of Holistic Kidney, a practice dedicated to the specialized needs of patients with kidney disease. A kidney patient herself since 1993, she brings a unique perspective shaped by firsthand experience across all stages of renal disease. Dr. Henderson is a graduate of the University of Bridgeport and has lectured extensively throughout the United States to naturopathic physicians, patients, and kidney care professionals.

Her work focuses on bridging the gap between conventional nephrology and natural medicine, helping patients navigate complex and often conflicting information to develop individualized, stage-appropriate care plans. Through her clinical practice and educational efforts, Dr. Henderson is committed to empowering patients with practical, integrative strategies to support kidney health. She can be found at Holistic Kidney on Facebook.