The aim of this study was to examine the occurrence of end-stage renal disease (ESRD) in Slovak children, to compare it with earlier Slovak data and with data from other European countries, and to explore etiology. Over the years 2003-2009, data on the incidence and prevalence of all cases of ESRD in children from all four Slovak tertiary pediatric centers were collected. The data were compared with two earlier Slovak studies and with European data from the European Society of Paediatric Nephrology. The median annual incidence rate of ESRD in Slovak children under 15 years of age was 6.6 per million age-related population (pmarp). The prevalence rate on 31 December 2009 was 24.1 pmarp. Compared with the last study (18.6 pmarp), the differences were not statistically significant. The comparison with neighboring countries and with the European average shows no significant difference in incidence, while prevalence is significantly lower compared to neighboring Austria and some other (mostly western) European countries as well as the European average. In conclusion, during the past decade, the incidence and prevalence rates of ESRD in Slovak children have remained stable. Compared to the European average, the prevalence in Slovak children is significantly lower.