Objectives: Survival of elderly patients on maintenance hemodialysis (MHD) is usually shorter than the younger. The 5-year survival probability of elderly patients on MHD in the 65-74 age group from the USRDS Annual Report was 34%. Observation on long-term survival among Asian elderly patients on MHD is scarcely found. We studied long-term survival of Thai elderly patients who received MHD. Methods: This retrospective study was conducted at Bhumirajanagarindra Kidney Institute Hospital, Bangkok. All incident and prevalent patients aged > 65 years, who had been on MHD for more than 3 months from January 01, 2012 to September 30, 2022, were enrolled. They were follow-up until the end of 2022. Baseline clinical characteristics, the cause of end-stage kidney disease(ESKD), dialysis vintage, and the cause of death were collected. Kaplan-Meier method was used for analysis of the 5-year survival probability. Results: During the period of observation, the total number of elderly patients on MHD was 536. The numbers of patients in the 65-74(Group 1), 75-84(Group 2) and >85(Group 3) age groups were 210, 248 and 78, respectively. The median survival times of Group 1, Group 2, and Group 3 were 107, 85 and 60 months respectively Table1.The 5-year survival probability of each group was 87%, 72% and 46%, respectively (P <0.001, Figure1). The 2 major causes of death were cardiovascular diseases(35.3%) and infectious related-diseases(25%). The 5-year survival probability was not different between patients who had ESKD from diabetes and those from non-diabetic causes.(74% vs. 79%, P = 0.80). Conclusions: This is a large-scale retrospective study exclusively in elderly patients in Thailand. The 5-year survival probability of Thai elderly patients on MHD decreased along with their ages. The 5-year survival probability of those who had ESKD from diabetes was similar to those who had ESKD from other causes.