Patients with advanced chronic kidney disease (CKD), particularly those receiving maintenance dialysis, have a rising percentage of older patients. The management of dialysis is evolving over time due to the shifting demographics of the dialysis population, with numerous overlapping problems between nephrological and gerontological care. Frailty is a physiological condition characterized by greater susceptibility to stresses as a result of diminished physiological reserves or physiologic system dysregulation. A composite of impaired physical function, exhaustion, reduced physical activity, and weight loss has been operationalized as the concept of frailty. CKD predisposes to frailty through many potential mechanisms; anemia, bone mineral disease, oxidative stress, and malnutrition which in turn lead to progression of CKD culminating in a vicious cycle. Elderly CKD patients frequently have frailty, which is related to reduced physical function, disability, a lower quality of life, and a lower survival rate. Prevention and treatment of frailty in the elderly CKD patients often require a multifaceted and individualized approach. This lecture discusses the importance of frailty as well as its pathogenesis, screening methods, prognostic implications, and management approaches in elderly ESKD patients.