Decision making in elderly patients with advanced kidney disease.

Because the fastest-growing group of patients undergoing dialysis is older than 75 years, geriatricians will be more involved in decisions regarding the appropriate treatment of end-stage renal disease. A thoughtful approach to shared decision making regarding dialysis or nondialysis medical therapy (NDMT) includes consideration of medical indications, patient preferences, quality of life, and contextual features. Determination of prognosis and expected performance on dialysis based on disease trajectories and assessment of functional age should be shared with patients and families. The Renal Physician Association's guidelines on shared decision making in dialysis offer recommendations to help with dialysis or NDMT decisions.