This thesis describes a prospective study of health outcomes in chronic dialysis patients in ten centres across Europe. There are five main aims: - To describe and compare patients entering chronic dialysis programmes across Europe; - To examine the effect of referral to a nephrologist and transition onto dialysis on early QOL; - To establish the contraindications to haemodialysis and peritoneal dialysis and identify a cohort of comparable patients for comparative studies; - To overcome variations in defining and recording new ESRD patients in different countries; - To compare health outcomes among the ten participating dialysis centres. Among incident patients (n=361), a smooth transition onto dialysis was associated with better early QOL, highlighting the importance of reducing the proportion of patients followed by a nephrologist who require an urgent first dialysis. In the subset of patients suitable for both haemodialysis and peritoneal dialysis, approximately equal numbers choose each modality. In this homogeneous cohort no difference in physical or mental QOL was found in baseline between the two modes of dialysis. However, follow up of these patients found general QOL and mental QOL to improve significantly in patients commencing treatment on haemodialysis, while no significant change was observed in QOL of those beginning on peritoneal dialysis. Incident dialysis patients in west European centres were older and more co-morbid than in central and east European centres. After adjusting for differences in casemix differences in health outcomes were found, with one centre, Thessaloniki, having significantly better QOL, haemoglobin and hospitalisation rates than the reference centre, Aberdeen. The heterogeneity of the centres makes linking single processes of care to improve outcomes difficult, but this study found no link between staffing levels and better health outcomes. Further research into how the health and culture of general populations influences outcomes in dialysis patients is now necessary.