Taiwan has highest end-stage renal disease prevalence in the world, beside the increasing of type II DM and other chronic disease patients, population aging is another important reason. According "2015 Annual Report on Kidney Disease in Taiwan" ESRD patients older than 65 years firstly became over 50% of Taiwan all incident ESRD patients in 2005 and then had been increasing to 55% until 2013. Except renal failure, geriatric ESRD patients usually concurrent with degenerative disease and other chronic disease, so we should have different thinking in caring elderly ESRD patients to young ESRD patient. On the other hand, the necessity of having renal replacement therapy in those elderly ESRD patients who are with severe comorbidity and poor prognosis, is one of important ethical issue has be discussed.