AbstractPlasma exchange (PE) is an extracorporeal blood purification technique designed for the removal of large molecular weight substances from plasma. Data regarding the use of PE in elderly patients is lacking, so this study analyzes the database of the Department of Dialysis at the University Hospital Center Zagreb (634 patients, 6237 procedures) for indications and complications in patients aged 65 years or older who were submitted to PE during the period from 1982 to 2007. A total of 50 patients in this age group were submitted to PE; their median age was 69 years (range 65–83). This population underwent 323 episodes of PE, mostly with albumin solution as the replacement fluid (94.0%), and blood access was usually via peripheral veins (72.0%). The most common indication for therapy (76.0%) was neurological (e.g. myasthenia gravis and Guillain–Barré syndrome), which was more common than in the entire population (i.e. of all age groups) (60%). The second most common indications were hematological diseases, followed by intoxications and Goodpasture's syndrome. Ninety‐four percent of patients showed improvement, two patients with Guillain–Barré syndrome died, and a patient with pemphigus vulgaris had no change in clinical status, compared with 75% of younger patients whose status improved after PE. Complications occurred during 11.5% of treatments, compared to 3.9% in the younger group. The most common complications were clotting (3.7%), blood access difficulties (1.5%), mild‐to‐moderate allergic reactions (1.5%), and precordial oppression (0.6%). Plasma exchange is rarely used in the elderly population; however, when carried out by experienced staff, it is a safe and efficient method that may significantly improve the outcome of elderly patients with appropriate indications.