The US population of adults older than 75 years is expected to double by 2030.1 The question of how best to manage older adults who develop progressive chronic kidney disease (CKD) is of critical importance. Patients who start dialysis therapy early, at estimated glomerular filtration rates (eGFRs)>10mL/min/1.73m2, accounted for most of the growth in the US dialysis population between 1996 and 2005.2 This trend to early start is more prominent with increasing age.2 A disturbing feature of the early start trend is a yearly increase in the percent of new starts with eGFRs>15mL/min/1.73m2 between 1996 and 2008.