Differences in patient populations do not explain the variations in mortality rates. The incidence of new patients and the prevalence of older patients and patients with diabetes are higher in the United States than in other countries and are continuing to rise. However, these numbers are rising in other countries as well without a concomitant increase in their mortality rates. Black patients make up a disproportionate number of US dialysis patients, but they are less likely to die than white patients. US patients spend less time per week in dialysis than their European counterparts and use smaller dialyzers, resulting in lower clearance of solutes.