OBJECTIVES: In European countries, incidence and prevalence of End Stage Renal Disease (ESRD) are increasing. Discrepancies between countries and regions exist in the use of renal replacement therapies (RRT). Literature analysis, comparing haemodialysis (HD) to peritoneal dialysis (PD) in terms of mortality/morbidity and of patients' preferences provides no evidence relative to understanding differences in the provision of the various treatments offered. Due to the high costs and organizational issues of RRT, predicting future needs is essential for nephrologists and Health care authorities. Our aim was to project the impact of various therapeutic strategies on the number of ESRD patients and their distribution between existing dialysis techniques. METHODS: We projected the ESRD incidence and prevalence rates up until the year 2008. A Markov model was built using data from French national registers (French speaking PD register, French transplants organization) and specific surveys (Federation of non-profit private hospital establishments). Six Markov states were defined: No ESRD, in-centre HD (CHD), out-centre HD (OCHD), PD, Transplantation (T) and Death (D). Transition probabilities were assessed considering a one-year Markov cycle. A sensitivity analysis was performed on fundamental assumptions. RESULTS: The number of ESRD patients was projected to rise from 45,000 to 57,600, if 5% of incident patients at start of RRT were treated by PD, 58% by HDC, 22% by OCHD, and 4% transplanted. A substantial modification of the initial distribution of incident patients was needed to have a significant impact on the final distribution of patients between techniques. An increase of 5% to 20% of incident patients initially treated by PD, resulted in a rise from 6.7% to 8.6% of prevalent patients finally treated by that technique. CONCLUSIONS: ESRD is a French Health care priority. This Markov model could be very useful to planners in elaborating their Health care organizational schemes for the coming 5 years.