Background: We describe circumstances of dialysis initiation, dialysis prescription and factors affecting survival in elderly patients. Methods: We included all incident patients ≥80 years old from a National Registry for which clinical and laboratory data at dialysis initiation could retrospectively be obtained. Results: Of 170 patients included, 24% had diabetes, 30% ischemic heart disease, 13% peripheral arterial disease, 15% active malignancy and 60% prior nephrology care. Mean creatinine was 672 ± 225 µmol/l, eGFR 7.3 ± 3.7 ml/min/1.73 m<sup>2</sup>, 81% started dialysis in hospital and 78% with a catheter. 32% had <2 sessions/week and 29% had single-needle dialysis. One-year survival was 74% (median 26 months). In multivariate analysis only age (HR 1.10) and prior nephrology care (HR 0.48) were significant predictors of survival. Conclusions: The majority of elderly patients started dialysis with a catheter and in hospital setting. We estimate observed survival as good. Only age and prior nephrology care were independent predictors of survival. Video Journal Club ‘Cappuccino with Claudio Ronco' at www.karger.com/?doi=367681.