Objective To examine the structure, processes, and outcomes of American dialysis facilities that predominantly treat racial‐ethnic minority patients. Data Sources/Study Setting Secondary analysis of data from all patients who initiated dialysis during 2005–2008 in the United States. Study Design In this retrospective cohort study, we examined the associations of the racial‐ethnic composition of the dialysis facility with facility‐level survival and achievement of performance targets for anemia and dialysis adequacy. Data Collection/Extraction Methods We obtained dialysis facility‐ and patient‐level data from the national data registry of patients with end‐stage renal disease. We linked these data with clinical performance measures from the Centers for Medicare and Medicaid Services. Principal Findings Overall, minority‐serving facilities were markedly larger, more often community based, and less likely to offer home dialysis than facilities serving predominantly white patients. A significantly higher proportion of minority‐serving dialysis facilities exhibited worse than expected survival as compared with facilities serving predominantly white patients (p < .001 for each). However, clinical performance measures for anemia and dialysis adequacy were similar across minority‐serving status. Conclusions While minority‐serving facilities generally met dialysis performance targets mandated by Medicare, they exhibited worse than expected patient survival.