As the population ages, the number of elderly patients worldwide is growing who need renal replacement therapy due to end-stage renal disease (ESRD). Elderly patients with ESRD brings many difficulties to dialysis treatment due to aging, physiological functional decline, more complications, poor ability to maintain the self-regulation, and shorter survival expectancy. An elderly patient with ESRD has its particularity in dialysis treatment initiation and dialysis modality choice, so it is necessary to set up an individualized treatment plan according to the patient′s primary disease cause, evaluation on potential complications that may be caused by dialysis, and local medical and health conditions. In addition to the medical technical factors, other non-medical factors should also be considered, such as a patient′s life expectancy, expectation of quality of life, and the influence on the patient′s family.