Kidney disease is the ninth leading cause of death in the United States. Approximately 19 million U.S. adults have chronic kidney disease, and an estimated 80,000 persons have chronic kidney failure diagnosed annually. Major causes of chronic kidney failure are diabetes mellitus and hypertension, which account for approximately 60% of new cases. To assess national and state-specific trends in the prevalence of chronic kidney failure during 1990-2001, CDC analyzed data from the United States Renal Data System (USRDS). This report summarizes the results of that analysis, which indicated that the prevalence of chronic kidney failure in the United States increased 104% during 1990-2001. Treating and controlling risk factors and screening persons at high risk for chronic kidney failure are key steps that health-care providers and public health practitioners can take to reverse the upward trend in this disease.