Time to Recast Our Approach for Older Patients With ESRD: The Best, the Worst, and the Most Likely

The 1972 enactment of the End-Stage Renal Disease (ESRD) Medicare Entitlement Program transformed ESRD from a fatal diagnosis for all but a lucky few chosen to receive dialysis into one in which death could be deferred with dialysis, potentially for decades, for virtually anyone. As a result, the population undergoing dialysis has transformed from a relatively young and otherwise healthy group into an older group with a substantial burden of comorbid conditions in addition to ESRD.1,2 Many of the oldest dialysis patients will not live longer because of their dialysis treatments, but instead will disproportionately experience ill effects from being on dialysis therapy.

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