Kidney disease was the ninth leading cause of death in Michigan in 2005 and in the United States in 2004. In 2004, the incidence rate for kidney failure (i.e., end-stage renal disease) was higher in Michigan than in the United States (365 versus 353 per 1 million population). A total of 3,695 Michigan residents started treatment (i.e., dialysis or transplant) for kidney failure in 2004; by the end of that year, 11,002 Michigan residents were receiving dialysis, and 614 had received a transplant. Many of these persons had a diagnosis of diabetes (40%) or hypertension (30%) as the primary cause of kidney failure. To examine recent trends in kidney disease mortality, the Michigan Department of Community Health (MDCH) analyzed vital statistics data from the period 1989--2005. This report describes the results of that analysis, which indicated that kidney disease mortality is a growing public health problem in Michigan and that blacks were more likely than whites to die from kidney disease. Continued disease-prevention and health-promotion activities, including targeted interventions among populations at greatest risk, are needed by MDCH and other organizations to reduce the burden of kidney disease in Michigan.