OBJECTIVES: To compare the health-related quality of life (HRQoL) and the prevalence of depression of older adults with stage 5 chronic kidney disease (CKD) on haemodialysis versus non-dialysis therapy. METHODS: This cross-sectional study was conducted in six haemodialysis centres located in the Klang Valley, Malaysia. We administered the EuroQol EQ-5D and the 4-Item Geriatric Depression Scale (GDS-4) to older adults aged 65 and above with stage 5 CKD (eGFR <15mL/min/1.73 m2): 100 participants were undergoing haemodialysis and 100 were on optimal medical therapy for at least 90 days. Demographic and clinical data were collected from the medical records. Independent t-test, Pearson’s chi-square test, Fisher’s exact test and the Mann-Whitney U test were used to compare participant characteristics, EQ-5D index, EQ VAS and GDS-4. RESULTS: Median age for the haemodialysis population was 71 years; 79% were Chinese, 14% Malay, 6% Indian and 1% were from other ethnic origin. Median age of the non-dialysis population was 73 years; 44% were Chinese, 34% Malay, 20% Indian and 2% were from the other ethnic origin. Gender and co-morbid conditions were not statistically different between the groups. The EQ-5D index was significantly lower in the haemodialysis population, median = 0.673 (IQR 0.363-0.814) compared to those on non-dialysis therapy, median = 0.727 (IQR 0.620-0.848), p = 0.02. The participants on haemodialysis scored lower EQVAS, mean (SD) = 54.9 (13.8) compared to the non-dialysis population, mean (SD) = 62.1 (13.4), p < 0.001. Older adults undergoing haemodialysis were more likely to be depressed (GDS-4: 1-4) than those on non-dialysis therapy, χ2 = 14.5, p < 0.001, OR 3.17. CONCLUSIONS: Among older adults with stage 5 CKD, HRQoL was significantly worse among those undergoing haemodialysis compared to those on non-dialysis therapy. Healthcare providers must move beyond traditional renal-specific goals and aggressively treat symptoms in older people undergoing haemodialysis.