Peritoneal dialysis in the elderly

The elderly on dialysis have unique needs and characteristics and their outcomes vary from those of their younger counterparts. Comparatively fewer will start or be maintained on peritoneal dialysis (PD) compared to younger patients despite the fact that haemodialysis is often poorly tolerated. A home-based treatment also avoids the need for transport which can be expensive and adversely affect the quality of life of a patient. Barriers to PD for older patients include poor vision, frailty, cognitive dysfunction, accommodation issues and a prejudice from renal teams that older patients cannot do PD. In France, where assistance from community nurses has been available for many years, PD is predominantly a treatment for the elderly and older, sicker patients are often preferentially placed on PD. The use of assisted PD is growing in other countries and where this happens, there is a growth in the prevalent PD population. The ability of older patients to use PD as their dialysis modality should not be determined by whether they live in an area where the nephrologist is a PD enthusiast or not. Patients have the right to receive appropriate non-biased information so they can choose the dialysis modality which gives them the best quality of life and suits their and their family's lifestyle.