Care of the geriatric patient in chronic renal failure

Currently, there are around one million chronic dialysis patients worldwide. More than half of these are older than 65. For various reasons this is a fast growing population. When the indication is considered to start dialysis, a distinction must be made between biological age in the third and fourth decade on the one hand, and a specific geriatric profile on the other, which implies adequate gerontological knowledge. Besides the patient-directed choice of the best tolerated treatment technique, the specific treatment of age-linked polypathology as well as the appropriate approach of inter- and intradialysis related problems regarding access and haemodynamics are the best guaranties of success in this highest age dialysis group. By means of a multidisciplinary geriatric assessment, which makes it possible to carry out an objective analysis and observation from the somatic, psychic and social points of view, an ultimate objective is achieved: the improvement of quality of life by means of rehabilitation. The survival of elderly dialysis patients has favourably evolved since the 90's after the introduction of EPO, bicarbonate dialysate, the monitoring of dialysis adequacy and support of prognostic and comorbid factors. The problems surrounding dialysis drop-out is a sensitive and controversial matter in which well founded communication with the patient, the family, the dialysis team, domestic care and the general practitioner is vital. "Add life to years and not years to life" remains a challenge for every nephrologist.