Background: The etiology of End Stage Renal Disease (ESRD) in every community differ according to genetic, nutrition, and public health status. ESRD,the terminal stage of chronic renal failure,needs replacement therapy otherwise could lead to death. The aim of the study is to determine the relative frequency of ESRD etiology in hemodialysis patients of Gilan province.

Methods:This descriptive study was performed on 407 patients who were being hemodialysis in all hemodialysis centers of the Gilan province from September 2002 to September 2003. The original data was collected from the medical records of patients.

Results: The most prevalent causes were: hypertension 35.4% unknown etiology 16.2% diabetes melitus 13.8% , glomerulopathies 9.6% , urologic causes 9.1%, cystic kidney diseases 7.6 % other causes 5.9 % congenital 2.5%.

Conclusion: In our study hypertension was the first etiology of ESRD, followed by unknown causes, however nephrology textbooks indicate diabetes melitus as the primary and hypertension as the secondary etiology of ESRD,.