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Patients older than 75 years of age currently represent more than 35% of the population that begins dialysis each year in most European registries; in our centre, at least 30 patients in this age bracket begin dialysis, which represent 45% of the total incident patients. The absence of systematic studies makes this patient category almost indistinguishable from other categories, even though its peculiarity is now becoming evident. At least 30–40% of elderly individuals are expected to be frail and/or dependent, but the incidence of frailty is likely to be higher in those undergoing haemodialysis. Due to severe physical and/or mental impairment and often because of social hardship, these patients rarely experience clinical stability and are dependent on third parties for their survival. Early symptoms of frailty consist of weakness, anorexia, weight loss, muscular atrophy, reactive depression and cognitive deficits. Commonly, early signs and symptoms are underestimated until patients become depende...