Incidence of treated end-stage renal disease (t-ESRD) in Saudi Arabia is not well documented and only few reports are available. This study was conducted to determine the incidence of t-ESRD in Asir region. The study period included January 1995 to December 1995. All new cases admitted for chronic dialysis treatment in all MOH-hospitals with a diagnosis of ESRD were included. There were 114 Saudi and 10 non-Saudi Patients. Among the 114 Saudi patients, there were 64 (56.1%) males and 50 (43.9%) females. Mean age 47.86 +/- 19.86 years (range 9-90 years). The overall incidence of t-ESRD was 214.9 pmp. Age adjusted incidence for males and females were 243 pmp and 186 pmp, respectively. There were no differences between males and females (X 2 =2.019, p = < 0.05). The majority of the patients (41.2%) did not have definitive diagnosis. Among the known causes, glomerulonephritis was diagnosed or suspected in 56.7%, diabetes was the cause of ESRD in 16.4% of the cases. This is the highest incidence of ESRD ever reported in Saudi Arabia. Geographical, environmental, genetical factors may have been contributing factors.