In this prospective study, we show that the incidence of treated end-stage renal disease (ESRD) in Madinah Munawarah Area-Saudi Arabia (KSA) increased from 65.2 per million population (PMP) in 1988 to 137.5 PMP 2001. The highest incidence (40.6 %) was in the age group 40 to 59 years with predominance of males (61.6 %). Diabetes mellitus was the major etiology of ESRD in this area (42.5 %) and remained as such over the past 11 years; this is the highest figure for this etiology in KSA. Hypertension as a co-morbidity is very common (74.5 %). All diabetics were hypertensive at the start of renal replacement therapy (RRT). Ischemic heart disease is common in the chronic renal disease patients before RRT (27.4 %). Most patients presented very late with ESRD (69.9 %) without previous correction of the modifiable risk factors. The medical and general community at large should be informed of the benefits of early correction of the modifiable factors and the safety of the present RRT.