Acute arthritis and periarthritis are known to develop in patients undergoing long-term hemodialysis; however, the long-term consequences of hemodialysis on joint structure and function have not been thoroughly evaluated in a cohort of patients. All patients (11) undergoing hemodialysis for 10 or more years were evaluated for symptoms, joint function, and radiographic abnormalities. Eight patients had joint symptoms, excluding those from a septic or traumatic process. Only four patients had acute episodes of arthritis. Nine patients had abnormalities on physical examination, including decreased range of motion, joint effusion, crepitance, or deformity. Nine patients had abnormal findings on radiography, including narrowing, erosions, and calcification. Those with more severe disease were younger and had been receiving dialysis treatments longer. It is concluded that prolonged hemodialysis is associated with a progressive deterioration of joint structure and function with or without acute episodes of synovitis.