Chronic kidney disease is now considered a public health priority, and the prevalence of this disease is approximately 10% in both North American and European countries. Such a phenomenon raises concern about the future increased incidence of ESRD. A recent analysis in the European Renal Association-European Dialysis and Transplant Association Registry shows that the incidence rates in Northern European countries have stabilized at approximately 110 per million people, a phenomenon that is associated with a parallel stabilization in the incidence of ESRD caused by diabetes. Such a stabilization has occurred in the face of an increasing prevalence of diabetes and hypertension in the general population, suggesting that this improvement may be the result of better prevention. Genetic factors, competing risks with other diseases, and other medical factors explain only in part the variability in the incidence of renal replacement therapy in European countries. Health care financing priorities have an obvious influence on the outcome of ESRD. Nonmedical factors seem to be of importance at least equal to that of medical factors. In this respect, Dialysis Outcomes and Practice Patterns Study Europe has revealed relevant differences in clinical policies that are related to ESRD treatment among European countries.