Background: End-stage renal disease (ESRD) has become a health issue worldwide. There is electronic data registry in developed countries, which allows for quick statistical analysis and assessment of the issue size for future planning. Objective: The aim of the study was to assess the prevalence rate, etiology, and risk factors for end stage renal disease (ESRD) in Aswan governorate, Upper Egypt, during the period from June 2017 to June 2018. Patients and methods: Our study was subjected to Patients with end stage renal disease on maintenance hemodialysis. This cross sectional study was carried on 1000 patients with ESRD in Aswan governorate from June 2017 to June 2018 Results: The etiology of ESRD was unknown in 13.7% of cases, whereas hypertension was responsible for 19.6 % of cases, diabetic nephropathy was 19.5 % of cases, Obstructive uropathy was 14.5 % of cases, Glomerulonephritis was 7.1 % of cases, Chronic Pyelonephritis was 5 % of cases, Congenital was 4.9 % of cases, Analgesic Nephropathy was 4.8 % of cases, Preeclampsia was 3.6 % of cases, Poly Cystic Kidney was 3.3 % of cases, Gouty Nephropathy was 2.5 % of cases and lastly Lupus Nephritis was 1.5 % of cases. Conclusion: In Aswan Governorate, the most common cause of ESRD was hypertensive renal disease followed by diabetic nephropathy then Obstructive Uropathy followed by Unknown cause.