Chronic renal failure (CRF) in elderly patients has insidious onset, atypical manifestation, and slow progression, which is prone to misdiagnosis, missed diagnosis, or delayed diagnosis. There is currently no convincing evidence that a certain estimated glomerular filtration rate (eGFR) formula is more suitable for the evaluation of renal function in elderly patients with CRF. Serum cystatin C (Cys C) is a recently-introduced new detection for eGFR. Whether Cys C is superior to serum creatinine (Scr) in assessing renal function of especially the elderly, still needs more related studies. The conservative treatment for the elderly CRF should include finding out the reversible factors for kidney function deterioration, performing treatment for other systems′ diseases, implementing individualized low protein diet, limiting salt or water intake according to the disease condition, controlling hypertension, and delaying chronic kidney disease (CKD) progression and cardiovascular disease occurrence; whether dialysis treatment can effectively improve prognosis of elderly CKD patients is still controversial, because currently there are only results of observational researches; and age itself is not a taboo condition for kidney transplantation. Studies have shown that kidney transplant can prolong the survival time and improve the quality of life of patients. Due to the particularity of kidney transplantation in the elderly, the assessment on all the aspects should be more cautious before the kidney transplantation.