Patients undergoing kidney biopsy are increasingly older. We aimed to evaluate the clinical utility of kidney biopsy, long-term clinical outcomes, and safety of high-risk biopsies in older adults undergoing kidney biopsy in a multi-ethnic Southeast Asian cohort.We performed a single-center retrospective study of older patients (age ≥ 60 years) who underwent native kidney biopsies between June 2011 and March 2015. The primary long-term outcome of interest was a composite of ESKD or death. The safety outcome of interest was post-biopsy bleeding in the high-risk subgroup, defined by serum creatinine 150 µmol/l.Older adults accounted for 153 of 545 (28.1%) native renal biopsies performed. The median age of these older adults was 66.6 (IQR 63.0, 70.6) years. Kidney dysfunction was frequent and severe in this cohort, with 41.2% having eGFR 30 ml/min/mOur study confirmed the utility of kidney biopsy in older adult patients for diagnosis and management, although risk counselling and close monitoring for bleeding complications is necessary.