Valvular heart disease accounts for considerable morbidity and some mortality among patients with end-stage renal disease (ESRD). To determine the prevalence and severity of valvular and perivalvular abnormalities, including valvular thickening, stenosis, calcification, regurgitation, and mitral annular calcification (MAC), and the impact of age and duration of dialysis on valvular disease in these patients, we reviewed Doppler echocardiograms in 75 consecutive patients requiring hemodialysis for ESRD. Our results showed that valvular sclerosis, calcification, and MAC were common in patients requiring hemodialysis; valvular regurgitation was both more prevalent and more severe in hemodialysis patients than in "normal subjects"; and age of the patient and duration of dialysis were related to the prevalence of valvular disease in ESRD. These findings suggest that Doppler echocardiography should be frequently used to assess possible valvular heart disease in patients receiving hemodialysis for ESRD, particularly older patients, those who have received dialysis for several years, and those with suspected valvular disease based on history and physical examinations.