Peritoneal Dialysis Is the Best Modality for Old, Frail People

An ageing population in the UK has seen an increased prevalence of chronic kidney disease (CKD), with a higher proportion of old, frail people requiring kidney replacement therapy. This article aims to explore why peritoneal dialysis (PD) may be the optimal dialysis modality for older people, considering factors such as frailty and cognitive impairment. PD offers considerable benefits over haemodialysis, including improved quality of life, benefits to cognition and higher treatment satisfaction. Assisted PD supports the maintenance of treatment for those with physical or cognitive impairments and helps to alleviate caregiver burden. Despite this, challenges such as treatment burden and peritonitis should be thoroughly considered. Overall, PD aligns well with the priorities of older people, emphasising quality of life and autonomy over survival. However, there needs to be improved funding and access to assisted PD programmes going forward to ensure PD is a viable treatment option.