This thesis presents 11 research papers undertaken during the last decade which address various aspects of the epidemiology of endstage renal failure (ESRF) and the provision of renal replacement therapy (RRT) in England. Such therapy has been one of the great success stories of modern health technology as it is life-saving for this uniformly fatal condition. However, it is resource intensive, has a high cost and therefore it has been subject to intense interest over the last four decades from the standpoints of equity, effectiveness and cost effectiveness. Whilst the RRT programme in the UK and England had expanded by the early 1990s, there was still concern about unmet need, changing patterns of dialysis, the needs of certain ethnic minorities, the problem of patients being referred late for RRT, and uncertainty about future demand. The papers address the following aims: 1. To describe the evolving pattern of RRT provision in England, the key determinants of need for RRT and to investigate if there is geographical inequity. 2. To determine rates and causes of RRT in ethnic minorities. 3. To investigate the scale of late referral and the scope for its prevention. 4. To model future demand for RRT taking account of demographic, epidemiological, clinical and supply side factors. RRT is a significant and expanding health care technology. Transplant supply will need to increase substantially to slow the rate of haemodialysis growth. Whilst the National Service Framework for Renal Services Part 1 has outlined standards of care for RRT, strategies to prevent chronic kidney disease progressing to ESRF particularly in ethnic minorities, earlier referral of appropriate patients and planned vascular access before RRT are needed.