The number of elderly patients started hemodialysis (HD) has been increasing. This study aimed to investigate the clinical characteristics and mortality outcomes of elderly HD patients  Patients on HD were included in end-stage renal disease registry of the Korean Society of Nephrology between 2000 and 2019. Among them, incident HD patients aged ≥65 with registered current patients’ status and initial HD information were analyzed. Patients were categorized according to age at HD start, young-old (64-75 years), middle-old (75-84 years), and oldest-old (≥85 years) group. Mean patient age was 73.6 ± 6.2 years and 57.5% (7482 patients) were male. A total of 13,019 patients, there were 59.3% (7716), 35.0% (4562), and 5.7% (741) in young-old, middle-old, and oldest-old group, respectively. The proportion of oldest-old group has been increasing over the years; 0.6%, 1.3%, 2.2%, and 3.7 % in HD start year 2000-2004, 2005-2009, 2010-2014, and 2015-2019, respectively. HD less than 3 times/week and HD via central vein catheter were higher in oldest-old group. Body mass index was lower and serum albumin and phosphorous value were lower in oldest-old group. During follow-up period (23.0 ± 29.5 year), 73.3%, 72.1%, and 71.8% patients were dead in young-old, middle-old, and oldest-old group, respectively. In Kaplan-Meier analysis, survival rate was lower in oldest-old group (P < 0.001). Five-year survival rate was 56.3%, 39.8%, and 24.5% in young-old, middle-old, and oldest-old group, respectively. The rate of oldest-old patients is increasing in Korean HD patients and five-year survival rate was 24.5% in oldest-old group.