Diabetic nephropathy (DN) as a cause of end-stage renal disease (ESRD) is increa-sing worldwide. In some countries, it is the most common cause of ESRD. Our objective was to assess the incidence of DN as a cause of ESRD in Tabuk, to evaluate its changes in four years, and to compare the data of Tabuk with data from the United States (US) to be aware of factors causing the difference. Data of ESRD patients with DN treated with renal replacement therapy (RRT) was evaluated from 2009 to 2012. RRT was defined as ESRD patients who were treated either with chronic regular hemodialysis (HD), renal transplantation (Tx) or continuous ambulatory peritoneal dialysis (PD). The incidence of DN as a cause of ESRD increased from 8% in 2009 to 18% in 2012. The mean age of this group was significantly higher than in patients on RRT due to other etiologies. Also, DN was more widespread in built-up areas than pastoral areas. The mortality rate decreased from 20% in 2009 to 14% in 2012. Despite this decrease, the mortality rate was still higher than that in patients on RRT due to other etiologies. When we restricted our analysis to patients treated by HD (76%), Tx (17%) or PD (7%), the results were not significantly different. DN in the Tabuk area is rising, but is less widespread than in the US possibly because of an increased occurrence of other causes of ESRD or early loss of diabetic patients. Therefore, careful management of diabetic patients is obligatory.