Cardiovascular disease is the major cause of death in patients with end-stage renal disease, and the incidence of atherosclerosis-related complications is significantly higher in dialysis patients than in nonuremic controls. This study aimed at evaluating atherosclerotic involvement of carotid vessels in hemodialysis patients and in a group of subjects with a similar cardiovascular risk factor pattern using echo color Doppler ultrasonography. Carotid lesions have been evaluated, taking into account plaque characters (surface, echogenicity), the most severe luminal narrowing, and the number of vessels involved. A large number of vascular plaques has been observed in uremic patients: 73.8% versus 44% in the control group (chi square test = 10.98; P < 0.01). A high prevalence of carotid lesions has been found in both patients and controls with clinical evidence of cardiovascular complications. Finally, we have considered the presence of carotid lesions with a topographic evaluation. The presence of atheromatous lesions in hemodialysis patients compared with control subjects was statistically significant different in all the vessels except common carotid (internal carotid: chi-square test = 8.59, P < 0.01; external carotid; chi-square test = 13.46, P < 0.01; bulb chi-square test = 7.90; P < 0.01). Our data clearly show that the hemodialysis population suffers from a higher degree of atherosclerosis than age- and sex-matched controls with similar cardiovascular risk patterns, suggesting that the uremic state in conservative and substitutive treatment per se may contribute to "advanced" atherosclerosis. However, this does not enable us to state that hemodialysis accelerates atherosclerosis. In fact, the progression of atherosclerosis might be related to atherogenic factors operative before regular dialysis.