<p>A&#xa0;large proportion of patients with chronic renal failure are nowadays older than 80&#xa0;years. If the renal function continues to deteriorate, initiation of renal replacement therapy has to be discussed. Furthermore, specific questions arise on how to perform dialysis. This article is based on a&#xa0;selective literature review and summarizes aspects of the indications, prognosis assessment and practical implementation of dialysis in very old people. When deciding on whether dialysis is needed, it may be difficult to differentiate symptoms caused by renal failure from geriatric symptoms. In this case structured recording tools and follow-up observation may be helpful. Patients should be informed about all treatment options for end-stage renal failure, including conservative palliative therapy and should participate in the decision in the sense of shared decision-making. In this context age-specific aspects of patient education must be taken into account. In patients ≥ 80&#xa0;years of age with pronounced comorbidities, the prospective life expectancy with renal replacement is hardly higher than without. In such cases disease-specific and possibly treatment-specific burdens must be weighed against each other. The aim of treatment is then not to prolong survival but to improve the quality of life. Both hemodialysis and peritoneal dialysis can be carried out in very old people. The risk of intradialytic hypotension can increase with age. The treatment should be individualized as far as possible and the quality of life should always be kept in mind as the primary goal.</p>