With the ever increasing number of end-stage renal disease (ESRD) in the Kingdom; there is a need for continuous analysis on the existing burden of disease and utilize the best possible modality based on the outcome of the study. Retrospective study on the incidence and prevalence of ESRD, dialysis patient demographics and modalities based on cross-sectional study of annual questionnaires from all dialysis centers in the Kingdom. At the end of 2019, there were a total of 19,522 Hemodialysis (HD) patients including 4,146 new patients, having a 6% net annual increase for the past 5 years from 278 dialysis centers registered to SCOT. Majority of the patients are from age groups of between 26 to 65 years (67%) while a total of 112 (0.57%) patients were pediatrics (under 15 years) and 1,924 patients were above 75 years old representing 10% of the current HD population. In addition, the gender composition shows 10,835 (56%) males and 8,687 (44%) females and were divided between 83% nationals and 17% residents. The leading causes of ESRD are diabetic nephropathy 8,420 (43%), hypertensive nephropathy 6,679 (34%) and followed by unknown etiology at 1,715 (9%). Since 2010, there was a constant increase in the number of ESRD patients caused by diabetic nephropathy having an average increase of 7.15% for the past 5 years while hypertensive nephropathy had 5.85% average increase during the same period. The prevalence of hypertension (HTN) and diabetes mellitus (DM) among HD patients showed 13,736 (71%) and 10,528 (54%) respectively while the trend of prevalence as well showed a constant increase in the number of patients with DM & HTN having an average increase of 10% annually for the past 5 years. There was a significant decrease in the Hepatitis C Virus (HCV) infection rate among HD patients with 8% in 2019 vs. 24.5% in 2010. The types of vascular access shows 12,072 (62%) are on arteriovenousfistula (AVF), 5,827 (30%) on permanent jugular catheter, 980 (5%) on vascular graft and 477 (2%) on femoral catheter. The leading cause of ESRD among the HD population is DM, having a significant increase during the past decade The increase in the age of dialysis over 50 years and reduction of pediatric group during the past decade showed better detection of chronic kidney disease. DM remained as the major concern as the leading cause of ESRD in Kingdom and needs to be tackled to settle a national project for CKD focusing on early prevention and management of DM and obesity.