A . Meyrier ) A hopeless case ?

End-stage renal failure in an octogenarian with advanced congestive heart failure is a daunting challenge for the physician. Many of these patients cannot tolerate haemodialysis, due to severely impaired left-ventricular function, valvular disease or both. In such patients, peritoneal dialysis may be the only feasible option but home therapy is often impossible, due to age, comorbidity and lack of a suitable caregiver. In-centre intermittent peritoneal dialysis (IPD), which must often be performed for as many as 30 h/week, offers survival, at the expense of severely compromised quality of life. We present a seemingly hopeless case of end-stage renal failure in an 81-year-old patient with advanced congestive heart failure.