During the years 1973, 1974 and 1975, the average annual rate of new ESRD patients was 50.4/million in a 7-county region of Southeastern Michigan. There were marked differences in the rate of new ESRD cases which paralleled the proportion of black individuals in the population. The ESRD rate for the black population was not significantly different in 3 districts within this region, ranging from 125.4 to 159.4/million. The ESRD rate for the white population ranged from 29.4 to 41.3/million, white individuals in Detroit having a significantly lower ESRD rate than white individuals in the area immediately adjacent to the city. The reason for this difference is not apparent. The data indicate that black individuals are more prone to develop ESRD from glomerulonephritis, hypertension, and diabetic nephropathy. In addition, racial factors are an important consideration in health care planning for ESRD treatment.