A controlled, cross-over trial of bicarbonate versus acetate hemodialysis over a 24 wk period in 16 patients with end-stage renal failure has shown a significantly lower incidence of dialysis-related symptoms during dialysis with bicarbonate. The level of well-being in the intervals between dialysis was not appreciably affected by the dialysis mode. It is suggested that bicarbonate dialysis should be made available to all patients receiving regular hemodialysis for end-stage renal failure provided that this can be done reliably and safely.