Major consequence of chronic kidney disease is multiorgan dysfunction. Severity of clinical symptoms is in general associated with degree of renal dysfunction, however is not uniformly distributed among various organs and systems. Tailored conservative treatment is aimed at prophylaxis and slowing the progress of organ dysfunction. Nevertheless, the main target is to maintain the best available quality of life until renal replacement therapy is necessary. Current directions in the field of pediatric nephrology is to consider dialysis procedures whether peritoneal or hemodialysis as a footstep before the optimum renal replacement therapy via transplantation. The teamwork in the centre of pediatric nephrology and renal transplantation (CPNT) in the Cairo University Children's Hospital provide the best management for ESRD patients. Either conservatively through identifying the reversible causes of CRF, dealing with its consequences (e.g. anemia, hypertension, metabolic acidosis…etc) supplying nutritional, social and educational support together with the initiation of hemodialysis at the appropriate time and sending candidates for renal transplantation through the integrated management provided by the pediatric nephrologists, general surgeons, vascular surgeons, nurses, social workers and dietitians. Revising the data obtained from the patients' files coming for hemodialysis at our centre provided valuable information about the overall process of hemodialysis along the year 2007 on the same steps as the studied year 2006 in a hope to place our filing system on the doorstep of the Data Base Management System facilitating data retrieval, analysis and exchange with other centres working in the same field.