Would you be surprised if your dialysis patient died within the next 12 months? This question, known as the “surprise question,” though not yet part of routine nephrology practice, is perhaps the most important question we should ask ourselves at the beginning of each dialysis patient consult. The fastest growing incident group receiving dialysis in the United States is patients older than 75 years, and in Australia, half of all dialysis patients are older than 65 years and a quarter are older than 75 years.