Purpose: This study was conducted in order to investigate the relationship between stress in elderly patients on renal dialysis and health-related quality of life, especially the moderating effect of self-esteem. Methods: The structural equation model was tested by setting the stress of elderly patients on renal dialysis as a prediction variable, their health-related quality of life as an outcome variable and their self-esteem as a moderating variable. The participants were 443 patients from Seoul and Gyeonggi province who were over 65 years of age and on renal dialysis. Measurement tools were health-related quality of life, stress, and self-esteem scales. Statistical descriptive analysis, Pearson correlation coefficients, reliability analysis, Scheffétest and multiple regression analysis were used to analyze the data. Results: For these patients, stress had a significant negative correlation with health-related quality of life and self-esteem had a significant positive correlation. The level of self-esteem plays a moderating role in the relationship between stress and health-related quality of life among elderly renal dialysis patients. Conclusion: The results indicate that interventions that are effective in increasing self-esteem can help these patients cope with stress and increase their health-related quality of life.