In this study by Hsu et al, 177 570 individuals from a large integrated health care delivery system who volunteered for health checkups were followed up for a mean of 25 years for development of end-stage renal disease (ESRD). The importance of established risk factors such as older age, male sex, African American race, lower education attainment, diabetes mellitus, higher blood pressure, higher body mass index, higher serum creatinine concentration, and more proteinuria were all confirmed in this comprehensive evaluation. The 2 most potent risk factors were proteinuria and excess weight. Several novel independent risk factors for ESRD were identified, including lower hemoglobin level, higher serum uric acid level, self-reported history of nocturia, and family history of kidney disease. This result may allow better identification of patients with heightened risk for ESRD for early screening and implementation of timely preventive interventions.