Chronic kidney disease (CKD) is a significant healthcare challenge affecting Canadians, including patients living in northern Ontario. When CKD progresses to end stage renal disease (ESRD), patients become reliant on life-saving renal replacement therapy such as kidney transplantation, hemodialysis or peritoneal dialysis. However, a variety of factors, including geographic proximity to dialysis and transplantation centres, lack of preventative care, and insufficient resources/funding, strongly disadvantage ESRD patients living in northern Ontario compared to their southern counterparts, leading to poorer health outcomes. Overall, a multi-faceted approach is necessary to address these issues including strengthening preventative kidney care, facilitating increased kidney transplantation, enhancing dialysis access, and providing alternative dialysis solutions. Potential benefits include improving mortality and quality of life for Northern Ontarian patients living with ESRD and creating a more equitable and financially sustainable Ontarian healthcare system.