• Chronic kidney disease (CKD) in older adults can result from a combination of physiologic, age-related decline in kidney function, renocardiovascular risk factors and external insults.• The management of risk factors for CKD should be individualized with consideration of less aggressive targets for frail patients at risk of polypharmacy.• The Kidney Failure Risk Equation is a useful tool in the evaluation of and ongoing treatment for CKD for both general practitioners and nephrologists.• Clinicians should have open discussions with their older patients with CKD regarding their goals of care and the potential benefits and harms of renal replacement therapy.