The elderly dialysis patient presents several challenges to the nephrologist. Concurrent illnesses may complicate management, disabilities may interfere with mobility, hearing, and vision, and depression and mental incompetence may be present. For these reasons the physician and health care team should adopt a broad treatment plan, using expert help if needed in managing the patient and involving family members, clergy, and friends. While lifestyle changes are inevitable for the elderly with initiation of dialysis, satisfactory outcomes are possible. In the event of overwhelming illness and the patient's perception of the futility of continuation of dialysis, cessation of dialysis must be approached in a humane, considerate, and compassionate manner.