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Older adults with chronic renal insufficiency may need a geriatric pre-therapeutic assessment when the disease becomes severe. At this stage a discussion is needed on the most appropriate treatment: to initiate dialysis or pursue maximum medical management. A comprehensive geriatric evaluation (medical-psycho-social) follows a standardized procedure, which aims to reveal and quantify the limits and frailty of the older patient. However, beyond determining risk and survival thresholds, the consultation is an opportunity to record the patient’s story at a critical point in the evolution of the disease. A narrative identity emerges from the standardized questionnaire. As a result, the evaluating geriatrician can navigate the care pathway by interpreting quantitative data alongside the patient’s account. This interplay between heterogeneous data, resulting from an ongoing dialectic between analysis and perception, numbers and words, raw data and interpretation, eventually reveals which of the treatment options is most pertinent. To take into account the singularity of each patient’s situation, it is necessary to rank the collected data. The evaluation report thus takes the form of an argument-based essay rather than a succession of raw data points. This approach allows the patient and nephrologist to construct the care pathway in the light of new meaningful elements.