Treatment standard: CKD in the geriatric patient

The number of older people with chronic kidney disease (CKD) is increasing globally. The vast majority of these patients will die before they even have the chance to start kidney replacement therapy. Nevertheless, this clientele of older patients with CKD is often characterized not only by several concomitant diseases but also by frailty. This constellation comes with a general vulnerability and very heterogeneous courses of disease that need to be considered when it comes to diagnosis and treatment. The main difference compared with younger patients is that therapy and therapy decisions are often preceded by the need for assessments. These can relate to frailty, but also to closely related areas such as cognition, depression or malnutrition among others. The basic therapeutic approaches for CKD treatment in a geriatric patient may not differ fundamentally though from those for younger patients. This also holds true for standard as well as more novel medication administered for nephroprotection. The difference however, lies in the fact that personalized approaches are more frequently required due to survival probability, a more complex mix of chronic conditions, and individual patient's needs and aims. This also applies to the difficult decision as to whether a very old person with CKD G5 should be dialyzed or treated conservatively. Information from different areas should be incorporated into a joint decision-making process, which often requires intensive, patient-centered communication about the patient's preferences and prioritized treatment goals, psychosocial factors and their home environment, as well as their medical needs and prognosis.