Objectives: To describe one- and three-year clinical outcomes among elderly patients with end-stage renal disease (ESRD) initiated on dialysis and to evaluate whether baseline demographic, clinical, laboratory, and treatment-related variables are associated with mortality. Methods: We conducted a retrospective single-center cohort study of patients aged ≥60 years who initiated hemodialysis (HD) or peritoneal dialysis (PD) between 2019 and 2021 at a tertiary hospital. Baseline demographic, clinical, laboratory, and dialysis-related variables were extracted from electronic medical records. Overall survival following dialysis initiation was estimated using Kaplan–Meier analysis. Exploratory associations between baseline variables and mortality were evaluated using logistic regression. Results: Seventy-one patients were included (mean age 74.7 ± 8.9 years). One-year survival was 78.9%, declining to 64.8% at three years. Exploratory analyses did not identify any baseline demographic, laboratory, or treatment-related variable significantly associated with mortality. Hemodialysis was the predominant initial modality (91.5%). Mortality appeared numerically higher among patients initiated on PD, although this difference was not statistically significant. However, dialysis modality change occurred significantly more often among PD patients, with 33.3% transitioning to HD during follow-up (p = 0.006). Cardiovascular and infection-related events were the most common causes of death. Conclusion: Among elderly patients initiating dialysis, substantial mortality persisted at one and three years, and traditional baseline clinical variables did not reliably predict outcomes. These findings suggest that mortality risk in older adults may be driven more by cumulative vulnerability and multimorbidity than by isolated clinical parameters. Dialysis modality sustainability may represent an important treatment trajectory in geriatric ESRD care.