aging and esrd demographics consequences for the practice of dialysis the disproportionate increase in the prevalence of chronic kidney disease ckd and endstage renal disease esrd in the elderly is now recognized as a national and global reality among the major contributing factors are the aging of the population a growing prevalence of ckd greater access to care and increased comorbidities the utilization of renal replacement therapy in the geriatric population has concomitantly increased it is imposing enormous challenges to the practice of esrd care the largest of which may be to determine the best application of clinical performance targets to a population with limitations in life expectancy concurrently increased focus on quality of life will be required the effective dialysis practitioner will need to adapt to the aging esrd demographics with an increased focus on physical and mental wellbeing of the geriatric patient