To assess the survival of elderly patients in the United States beginning chronic dialysis for end-stage renal disease caused by diabetes mellitus, hypertension, glomerulonephritis, polycystic kidney disease, and other causes.A secondary analysis of data obtained from the Health Care Financing Administration.All Medicare end-stage renal disease patients 55 years of age or older (n = 95,394) who began chronic dialysis treatment in the US between 1982 and 1987.The 1-, 3-, and 5-year survival rates for each of six age strata and, within each strata, for each of the four most frequent causes of renal failure.Survival rates of dialysis patients fell precipitously, and much more rapidly for the study group than for the general population, as a function of advancing age. Older patients with diabetic nephropathy fared particularly badly, such that no patients with diabetic nephropathy aged 85 years or more survived 5 years.Mortality rates of patients older than 55 years beginning chronic dialysis treatment increased dramatically as age at initiation of dialysis increased. Clinically meaningful survival data should prove useful to persons making decisions about the initiation of chronic dialysis.