Dialysis patients carry higher rates of mortality than the normal population. The increased mortality among dialysis patients is associated with age, presence of comorbid conditions at starting dialysis, and poor nutritional status indicated by several nutritional markers and inflammation. This project sought to analyse these issues in a closely studied cohort of patients in South East Scotland. In the first study subjective global assessment (SGA) of nutritional status was interrogated as a possible independent risk factor for 122 prevalent dialysis patients. The results showed age, comorbidity, SGA and C-reactive protein were associated with patient survival, and that significant additional information was provided by measuring SGA. In the second study factors associated with survival were examined in 183 consecutive patients starting renal replacement therapy in South East Scotland in 2003 and 2004. The results revealed that age, comorbidity, initial access and serum cholesterol all affected patients survival. In the Third study this 2003 and 2004 cohort was compared with a similar cohort commencing dialysis between 1997 and 2000 in South East Scotland. The results showed that median age rose from 63 to 65 and comorbidity increased but 2 year survival rate was unchanged and there was a substantial reduction in hospitalisation. These improvements may be because between two studies the unit moved hospitals and gained more nephrologists and more rigorous audit was implemented particularly in the haemodialysis services.