The number of patients with end-stage renal disease continues to increase worldwide, but the 5-year survival probability for patients on dialysis remains low. Preservation of residual renal function (RRF) is widely recognized to be important in the pre-dialysis setting, but now, its benefit for health and quality of life in people on dialysis has been well established. Preservation of RRF has consistently been shown to improve circulating levels of inflammatory markers, middle molecule clearance, blood pressure, and other markers of dialysis adequacy. Residual renal function has also been associated with improved survival on dialysis. This article reviews strategies for preserving RRF in patients on dialysis to improve long-term survival in this population.