The Latin American Dialysis and Transplant Registry collects information on end-stage renal disease and its treatment in 20 countries of the region. By December 2005, a total of 257,974 patients were on renal replacement therapy, for a prevalence of 478.2 cases per million population; 57% were on hemodialysis, 23% on peritoneal dialysis, and 20% had a functioning kidney graft. The prevalence on renal replacement therapy continued to grow at a rate of approximately 6% annually. Hemodialysis continued to be the treatment of choice in the region, except for in Mexico, Nicaragua, El Salvador, the Dominican Republic, and Guatemala, where peritoneal dialysis predominated. Diabetes remained the leading cause of end-stage renal disease, and the highest incidences were reported in Puerto Rico (65%), Mexico (51%), Venezuela (42%), and Colombia (35%). Forty-four percent of incident patients were aged > 65 years. The rate of transplantation remained unchanged at 15 per million population, which is not sufficient to satisfy the demand of the growing number of patients in the waiting list. Close to 50% of transplants came from cadaver donors. A total of 137 simultaneous kidney-pancreas transplants were performed, 123 in Brazil, 6 in Argentina, 3 in Uruguay, 2 each in Colombia and Mexico, and 1 in Chile. In addition, 1 cardiorenal transplant (Argentina) and 1 liver-renal transplant (Chile) were reported. In conclusion, the incidence and prevalence of renal replacement therapy continued to grow. Prevention of chronic kidney disease and an integrated approach of affordable dialysis and transplantation are urgently needed in the region.