The number of dialysis patients is consistently growing and the dialysis population is aging. Of all age groups of dialysis patients, the higher prevalence rate is in the elderly group (aged 75 years and older). The elderly patients have a high rate of comorbidities. Chronic dialysis treatment is expected to prolong survival. Older age and comorbidities are among the most powerful prognostic factors for survival on chronic dialysis. Observational studies found that after adjustment for age and comorbidities, dialysis treatment does not confer survival advantage when compared to conservative management in elderly patients with multiple comorbidities. Comprehensive conservative management is targeted for those patients who are not expected to benefit from chronic dialysis. The focus is on patients' preferences, specifically regarding issues of quality of life, and not necessarily on prolonging survival. For this process, shared decision-making is the recommended strategy. The rate of patients who opt for conservative management varies between countries. There is no data from Israel in this regard, but it is assumed that the conservative option is underutilized. There are different reasons for the current situation, factors that: depend on the caregivers' side, are patient dependent, relate to the health care system and available services and some cultural aspects. Addressing these gaps may require further collection of data, construction of needed services for conservative management and education of the caregivers and the patients.