End-stage renal disease (ESRD) and chronic renal failure (CRF) among Canadian natives is more common than among the general Canadian population. The results of this study show the James Bay Cree in Northern Ontario in 1989 experienced ESRD prevalence rates 3.2 times greater than the national rate. The average annual incidence rates for 1981-1989 were 1.6 times the national rate. Methodological difficulties inherent in incidence and prevalence studies of native Canadians are examined. With tertiary treatment care facilities available only in southern urban centres, native Canadians in remote northern communities face considerable psychosocial disruption when seeking out medical assistance for ESRD such as renal dialysis services.