Patients over 80 years old with end-stage renal disease (ESRD) are increasing in recent years. Age is an independent risk factor for the survival of ESRD patients. However, studies on the choice of time and treatment approach for renal replacement therapy in these patients are limited. In this paper, we compared the effects of conservative and replacement therapy on survival rate and dialysis timing on life quality and prognosis, reviewed the options of different renal replacement approaches and the differences of therapeutic efficacies and complications between hemodialysis and peritoneal dialysis, in order to provide clinical evidence on the treatment decision-making for ESRD patients aged over 80 years.