Questionnaires were sent to 2, 421 dialysis units in February 1994, to determine the present status of renal cell carcinoma in chronic hemodialysis patients. The response rate was 59.9%. Renal cell carcinomas were detected in 273 dialysis patients between March 1992 and February 1994. The age of the 273 patients (216 males and 57 females) was 53.5±11.3 (mean±SD) years, and the mean duration of dialysis was 118.2±71.0 months. The clinical diagnosis was based on sonographic examination (128 case) and CT scan (106 cases). Only 26 of those patients were symptomatic. Acquired renal cystic disease was found in 224 of 271 renal cell carcinoma patients (82.7%). The 210 cases with renal cell carcinoma were histologically confirmed. Cell typing of 194 renal cell carcinomas revealed that 105 patients showed the clear cell subtype, 42 the granular cell subtype and 47 a mixed cell subtype. The relationship between cell types in renal cell carcinoma and the duration of hemodialysis was studied. Granular and mixed cell subtypes were prevalent among patients who had had more than 5 years of hemodialysis. 35 out of 269 patients had metastasis. In conclusion, 273 renal cell carcinomas were found in the two years preceding this report and the prevalence was the highest to be documented in the six most recent questionnaires. The incidence of renal cell carcinoma in dialysis patients was 15 to 18 times higher than that in the general population. The incidence of renal cell carcinoma in dialysis patients showed 187 renal cell carcinomas per 100, 000 dialysis patients per year.