To Do Or Not to Do Dialysis? That is the Question

Currently, patients older than 75 years are the fastest-growing group starting dialysis worldwide. However, the benefits of dialysis become doubtful among frail older patients and conservative kidney management (CKM) has emerged as a feasible therapeutic strategy for some patients, with a focus on quality of life and comfort. Even though it is a challenge to recognize which is the most suitable therapeutic option for elderly patients. We report a case of an 81-year-old woman who initially chose CKM, but later accepted to start hemodialysis due to difficult control of hypervolemia. During the period on dialysis, she had several complications, the most serious related to lower limb amputation, as a result of severe chronic ischemia. This case reflects the complexity of managing an older stage 5 chronic kidney disease patient, both on dialysis or CKM. Treatment decisions are complex and prognosis estimation is challenging. Time is essential to understand the benefits and burdens of different treatment strategies for each patient and the priority should be centered on optimizing care for older adults with advanced kidney disease.