[End-stage kidney disease in older adults : towards individualized decision-making]

Population aging and the high prevalence of chronic kidney disease in adults aged ≥ 65 years support a nephrogeriatric approach that integrates frailty, comorbidities, and individual care goals into the management of end-stage kidney disease. Kidney transplantation offers the greatest survival and quality of life benefits when a standard-criteria or living-donor graft is available. However, these benefits are not clearly demonstrated in older patients receiving marginal kidneys. Dialysis generally prolongs survival compared to conservative management, but this advantage diminishes with advancing age and multimorbidity, and it is accompanied by more hospitalizations. Conservative care prioritizes quality of life at the expense of shorter survival. Treatment decisions should therefore rely on geriatric assessment and shared decision-making with the nephrologist centered on patient's priorities.