What special issues face older adults who have dialysis?

Multiple issues. Older adults on dialysis tend to be sicker and have more associated health problems. This may adversely affect how well they do on dialysis. In addition, placing a good fistula for access may be more challenging as their veins may be small and scarred or "used up" from previous ivs or medical procedures.
Same as others. Only older adults usually have less reserve, tire easily and are more prone to infections.