Related Experiment Video
Updated: Mar 28, 2026

5/6 Nephrectomy Using Sharp Bipolectomy Via Midline Laparotomy in Rats
Published on: April 4, 2025
End-Stage Kidney Disease in the Elderly: Approach to Dialysis Initiation, Choosing Modality, and Predicting Outcomes
Joseph R Berger1, Vishal Jaikaransingh1, S Susan Hedayati1
1Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX; and Renal Section, Medical Service, Veterans Affairs North Texas Health Care System, Dallas, TX.
Abstract:
The number of patients with end-stage kidney disease 65 years and older is growing, and this growth is expected to continue. The presence of medical comorbidities, limited life expectancy, frailty, and poor functional status in these patients poses substantial challenges in clinical decision-making and provision of optimal care. Frailty is more common in elderly patients with CKD than without and is associated with poor outcomes. Several prognostic tools were developed to estimate the rate of CKD progression among elderly, and risk of mortality after dialysis initiation. Risk factors for CKD progression among elderly include low estimated glomerular filtration rate, high baseline proteinuria, acute kidney injury, low serum albumin, and presence of congestive heart failure. The decision to initiate dialysis in the elderly should take into consideration life expectancy, risks and benefits of each dialysis modality, quality of life, and patient and caregiver preferences. This article discusses common issues in the elderly with end-stage kidney disease, with particular emphasis on the impact of frailty and functional status, choice of dialysis modality and vascular access, and prognosis after dialysis initiation, to assist the nephrologist in making decisions regarding optimal care for this complex group of patients.
Related Concept Videos
Dialysis
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
Dialysis
Chronic Kidney Disease III: Interprofessional Care
Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion
Chronic Kidney Disease I: Introduction
Extracorporeal Removal of Drugs: Peritoneal Dialysis and Hemodialysis

