BACKGROUND Patients with end-stage renal disease (ESRD) on dialysis therapy have increased susceptibility to bacterial infection. Data regarding pyogenic liver abscess in this population are rare. METHODS We retrospectively examined all cases of pyogenic liver abscess in patients undergoing maintenance dialysis therapy in 2 tertiary referral centers. Medical records of patients with ESRD with a pyogenic liver abscess from January 1995 to September 2004 were studied. RESULTS Twenty-seven of 20,676 admitted patients with ESRD were found to have a pyogenic liver abscess. The major predisposing factor was diabetes mellitus (59.3%). The most common clinical symptoms were fever and chills (85.2%). A rare presentation of hiccup was noted in 2 peritoneal dialysis patients, and endophthalmitis was noted in 2 patients with liver abscess caused by Klebsiella pneumoniae. Abscesses were located mainly in the right lobe (70.4%) and presented as a solitary mass (74.1%). K pneumoniae was the most common bacteria isolated in blood cultures (51.9%) and liver abscess aspirates (37%). Invasive drainage approaches performed in 17 patients (63%) resulted in a unique complication of peritonitis in 4 peritoneal dialysis patients. The difference in mortality rates between patients who underwent invasive procedures and those who did not was not significant (P = 0.68). The overall in-hospital mortality rate of patients with ESRD with a pyogenic liver abscess was 33.3%. CONCLUSIONS Although pyogenic liver abscess is uncommon in patients with ESRD undergoing maintenance dialysis therapy, it is still a disease of significant mortality.