Aboriginal people in Canada have an increased prevalence of ESRD, are more likely to initiate renal-replacement therapy on hemodialysis, and are much less likely to receive a kidney transplant compared to non-Aboriginals. Once established on dialysis quality of care and survival is similar for Aboriginal and non-Aboriginal people with ESRD. Understanding issues central to the health and outcomes of Aboriginal patients with ESRD, and documenting potential inequities in care, is essential to guide strategies to develop a new model for delivery of services for management of ESRD among Aboriginal people. Two areas in particular require further investigation for Aboriginal people with ESRD, namely the need to further investigate potential barriers to kidney transplantation, and reasons for lower rates of peritoneal dialysis as a form of renal replacement therapy. Research in this area will enable targeted interventions to be developed in partnership with the Aboriginal communities, with a goal to increase the health outcomes and quality of life for Aboriginal people with ESRD.