In 1984 Sugimoto and Rosansky reported on end stage renal disease (ESRD)treatment rates for the Eastern US in AJPH[1].This was the first publication of comparative ESRD treatment rates by race,sex,and age for a sample of the US dialysis population.The US ESRD treatment program was the first,and is the only,government-funded program for a defined disease group.In 1972,funding for ESRD was provided as an amendment to social security legislation.Annually collected new dialysis and transplant patients (ESRD treatment incidence)were initially collected by the Health Care Financing Administration in their medical information system.Data reporting was improved in 1988 with the creation of the US renal data system (USRDS)that reports data on ESRD and chronic kidney disease (CKD)patients.The current report updates and examines the trends in the US ESRD treatment incidence since 1979.We describe the explosive and unplanned growth of this program and project future trends in the US and international ESRD treatment populations.