How to make a shared decision with older persons for end-stage kidney disease treatment? The added value of geronto-nephrology

Improving care for older people with end-stage kidney disease (ESKD) requires standards to be adapted to meet their needs. This may be complex due to their heterogeneity in terms of multimorbidity, frailty, cognitive decline, and healthcare priorities. As benefits and risks are uncertain for these persons, choosing an appropriate treatment is a daily challenge for nephrologists. In this narrative review, we aimed to: (1) describe the issues associated with healthcare for older people, with a specific focus on decision-making processes; (2) apply these concepts to the context of ESKD; (3) identify components and modalities of shared decision-making, and (4) suggest means to improve care pathways. To this end, we propose a geronto-nephrology dynamic, described here as the necessary collaboration between these specialties. Underscoring gaps in the current evidence in this field led us to suggest priority research orientations.