Fig. 1

Framework for management of advanced CKD in older adults. The competing risk of death from non renal causes due to comorbidities and slow loss of renal function, < 3 ml/min/1.73 m²/year of eGFR [25, 28,29,30], makes the likelihood of the need for a dialysis decision low. Patient’s comorbidities and other parameters are used in tools for survival projections ([34, 35, 38,39,40,41,42,43,44,45,46] https://www.qxmd.com/calculate/calculator/3-month-mortality-in-incident-elderly-esrd-patients). High comorbidity and poor functional status may eliminate any dialysis survival advantage [2, 6, 14, 18, 44, 45]. A patient’s priorities and goals should be considered in conjunction with advantages and disadvantages of dialysis (listed in Table 2), in the shared decision process