The past decade has seen substantial improvements in end-stage renal disease (ESRD) outcomes, especially mortality, in the United States. Incidence rates for treated ESRD have doubled for most age groups, probably because of improved survival among high-risk populations, such as patients with diabetes and hypertension. The ESRD patient population is becoming older and has a greater incidence of diabetes because of changes in the types of patients starting treatment. The number of patients added to the waiting list each year for transplants has increased dramatically, whereas the number of transplantations performed annually has remained relatively constant. Although transplantation is consequently less available than before, transplant survival, both of the patient and the graft, has improved dramatically. Length of stay for hospitalizations has decreased. Both dialysis mortality and all ESRD mortality have decreased. It is important to monitor such statistics to try and modify adverse trends in outcomes for patients with ESRD. The ability to monitor patient outcomes through national databases has improved greatly during the last decade. Large-scale population-based studies of practices and outcomes for patients with ESRD offer a potent addition to the previously available arsenal of research tools, which was previously dominated by studies from single or few institutions and more expensive randomized clinical trials.