The annual incidence of patients initiating chronic hemodialysis (HD) will double (~100K→~200K) over the next decade. Despite several advances, HD mortality rates remain extremely high and have not dramatically changed over the past several years. The United States Renal Data System (USRDS) is the largest epidemiological database of patients with end-stage renal disease (ESRD) throughout the US, and studies utilizing the USRDS and similar studies emanating from large dialysis providers have served as the benchmark for guiding the care of all dialysis patients in the US While these databases have been an excellent resource for testing hypotheses, lack of concomitant blood samples has prevented a large-scale clinical trial testing of hypotheses necessitating biological samples. To overcome this limitation, we established a ‘USRDS-like’ clinical trial with the largest US dialysis provider to prospectively acquire research quality demographic data and concomitant biological samples to test two specific aims: