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About the polder initiative

The POLDER initiative develops a care pathway for older patients with End Stage Renal Disease (ESRD). By assessing a geriatric assessment, patients and health care providers take into account all aging aspects in the treatment plan.  How frail is a person, and how does he function physically and cognitively?  

Understanding the effects of  chronic kidney failure on aging. And improving healthcare accordingly. 


Our aim


To prepare implementation of a national registry for chronic care in older patients with ESRD, to study determinants of adverse outcomes, implement interventions and improve outcomes for these patients.

We believe that the implementation of a geriatric assessment and a national registry in pre-dialysis care for older patients with ESRD will:

1) provide insights in determinants of adverse outcomes.
2) inform and benefit decision making trajectories for treatment modality, and
3) will improve outcomes for these patients. 



nationwide cooperation

POLDER is an acronym for Pathway for Older Patients Reaching End Stage Renal Disease

Multiple Dutch hospitals and academic centers cooperate to develop and improve healthcare for the older renal patient.

In a pilot project we study the feasibility of implementation of a geriatric assessment in routine pre-dialysis care. The POLDER study involves capturing the clinical and geriatric data in a national database and collecting biomaterial for future research.



We use a consensus based testset, maximum duration 1 hour. This set will be evaluated at the end of the pilot study.

Functional: Katz ADL-6, Lawton iADL, Hand grip strenght

Cognition: MOCA, 6-CIT, Letter Digit Substitution Test

Mood: Geriatric Depression Scale, Optimism check

Proms: SF-12 (QOL), Dialysis Symptom Index (DSI)

Nutrition: PG-SGA

Other: Charlson comorbidity index, Clinical judgement, Surprise question, Clinical Frailty scale, Caretaker questionnaire, Questionnaire on choice of treatment.



Improving healthcare for older renal patients

polder in a nutshell

  • The POLDER intiative is a cooperation between multiple peripheral and academic hospitals. By implementing the same care pathway - a geriatric assessment in pre dialysis care- we can learn from each other. 
  • Sharing knowledge and outcomes to improve healthcare is an important aspect of this care pathway. Both patients and health care providers (such as the nephrologist, geriatrician, renal nurse, dietician, and the social worker) should discuss the  outcomes and implications of the geriatric assessment.
  • If necessary, additional care can be provided, like dietary prescriptions, physiotherapy or other care. 
  • The POLDER project provides additional education for health care providers working in renal care. 
  • Clinical and geriatric data will be gathered in a nationwide database in order to investigate the effects of kidney failure on the aging process. 

results of the POLDER study

First results are presented at:

- Netherlands Nephrology Conference 2018/2019

- ERA-EDTA congress 2019: see abstract.