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Numerous studies have shown that dialysis may not be as beneficial to elderly, frail patients with chronic kidney failure and multiple comorbidities as comprehensive conservative therapy (CCT) and that dialysis may worsen the quality of life (QOL), increase hospitalization rates, and cause a significant decline in functional status. Several mortality predictors have been proposed to determine which patients would benefit more from CCT or dialysis. We estimated the short-term risk of death in an 81-year-old male patient with kidney failure and highly severe frailty using the REIN score, a dependable risk prediction model proposed by the European Renal Best Practice Group for the prediction of short-term risk mortality. This score indicated that the patient had a high chance of death in the ensuing three months. However, the patient's longer survival time and a notable increase in functional status and QOL following hemodialysis started to contradict the expected outcome. It is important to note that the patient had never undergone a frailty assessment before or had been on a nephrologist's follow-up. We suggest that uremia may exaggerate frailty levels in older persons and as a result, undermine the predictive usefulness of mortality prediction scores in this population., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: The research has been supported by Shota Rustaveli National Science Foundation of Georgia (SRNSFG) (Grant number) PHDF- 22-4619. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Metskhvarishvili et al.)