Offering peritoneal dialysis to the older patient: medical progress or waste of time?

Over the past decade the number of individuals of all ages started and maintained on peritoneal dialysis (PD) has been dwindling across the world with a shift in attitudes towards favoring survival over quality of life. While consistently registry data suggest HD and PD have different mortality trajectories, with poorer survival over time with PD, particularly few studies incorporate the intrusiveness of disease or the therapy into their analyses. In this review we offer arguments against a survival attitude and argue that the nondialysis care, hemodialysis and peritoneal dialysis, each have a unique place within the practice of geriatric nephrology and offer practical suggestions for the clinician.