The records of 320 hemodialysis patients at risk for developing ischemic heart disease (IHD) were examined to determine the influence of the established risk factors of blood pressure, smoking, serum triglycerides, and age on the incidence of IHD and to develop coronary risk profiles for the hemodialysis population. The role of packed red blood cell volume, race, sex, and cause of renal failure on the development of IHD were also examined. None of these risk factors alone, with the exception of age and chronic pyelonephritis, were found to contribute significantly to the incidence of dialysis-acquired IHD. When the joint contribution of these variables was analyzed using Cox regression analysis, race and diastolic hypertension also were discovered to contribute significantly to IHD. However, smoking and serum triglycerides were not found to be significant risk factors. From these data, it is concluded that older patients are at a greater risk than younger patients, that white patients are at a greater risk than black patients, that patients with elevated diastolic blood pressure are at an increased risk and that patients with chronic pyelonephritis as the underlying renal disease are at an increased risk.