In June 2000 the ERA-EDTA Registry office moved to Amsterdam and started collecting core data on renal replacement therapy (RRT) entirely through national and regional registries. This paper reports the pediatric data from 12 registries. The analysis comprised 3,184 patients aged less than 20 years and starting RRT between 1980 and the end of 2000. The incidence of RRT rose from 7.1 per million of age-related population (pmarp) in the 1980-1984 cohort to 9.9 pmarp in the 1985-1989 cohort, and remained stable thereafter. The prevalence increased from 22.9 pmarp in 1980 to 62.1 in 2000. Hemodialysis was the commonest form of treatment at the start of dialysis, but peritoneal dialysis gained popularity during the late 1980s. Pre-emptive transplantation accounted for 18% of the first treatment modality in the 1995-2000 cohort. The relative risk of death of patients starting dialysis in the period 1995-2000 was reduced by 36% [adjusted hazard ratio (AHR) 0.64 [95% confidence interval (CI) 0.41-1.00] and that of those receiving a first allograft by 42% [AHR 0.58 (95% CI 0.34-1.00)], compared with patients in the period 1980-1984. The prevalence of RRT in children has continued to rise, while its incidence has been stable for about 15 years. Patient survival has improved in both dialysis patients and transplant recipients. The development of this pediatric registry will form the basis for more-detailed and focused studies in the future.