End-stage renal disease in the very elderly

The prevalence of end-stage renal disease in the UK looks set to increase for several more years. Since CKD is essentially a disease of older age, and because age is no longer seen as a contraindication for treatment, it follows that older people are now the fastest growing group of patients starting dialysis. Sadly this has not always been matched by an increase in services necessary to support them on dialysis. Expansion of dialysis facilities does not necessarily mean that all 80-year-old patients with end-stage renal disease should be offered treatment, which will often be inappropriate because of functional impairment, or will become inappropriate in the setting of severe dementia, advanced cancer or other serious co-morbid illness. Many questions about the management of older people with end-stage renal disease remain unanswered. Well designed prospective studies are required.