Over the last 10 years an increasing number of patients worldwide have started dialysis or had transplantation. Many are elderly with complex comorbid conditions. Registries across the world all show a rapid and dramatic increase in the number of older patients accepted for renal replacement therapy. In addition, the number of patients who grow old on dialysis is increasing, leading to a marked change in the demographics of the renal population. Changes over time and across registries are discussed with reference to patient characteristics, survival statistics, and the trends seen with transplantation in the elderly.