Can quality of life be improved for the increasing numbers of older patients with end-stage kidney disease?

Quality of life is particularly important for older patients with end-stage kidney disease, particularly when likely survival is short because of the burden of comorbidities. The features of old age and frailty make it difficult to cope with both hemodialysis and peritoneal dialysis. Evidence exists that quality of life is better on peritoneal dialysis compared with hemodialysis, yet the majority of older patients are placed on hemodialysis. Older patients should therefore receive appropriate education to enable choice of the appropriate dialysis modality for their lifestyle. The development of assisted peritoneal dialysis will enable those who cannot perform their own dialysis to have their treatment at home. Delaying dialysis to a time when it is actually needed and discussing the option of conservative care will also improve the quality of the end-of-life phase for patients with multiple comorbidities and with a poor overall prognosis.