Over a six year span, 41 patients with end stage renal disease (ESRD) were treated for 53 episodes of upper and lower gastrointestinal (UGI & LGI) hemorrhage. Thirty-two patients (78%) were diagnosed as having UGI bleeding and nine patients as having LGI bleeding. Mucosal inflammation of the esophagus, stomach and duodenum were the predominant etiologies of UGI bleeding (64%). The predominant cause of LGI hemorrhage was diverticular disease (33%). Angiodysplasias were found in six patients (15%), four with UGI bleeding and two with LGI bleeding. In the UGI hemorrhage group 20% of the bleeding episodes were recurrent and 13% were from multiple sites. There were no recurrent bleeding episodes in the LGI hemorrhage group. We therefore conclude that UGI bleeding is much more common than LGI bleeding in ESRD patients, and that there is a significantly higher tendency for recurrent bleeding episodes and for multiple bleeding sites in the UGI hemorrhage patients. We also note a higher prevalence of angiodysplasias of the upper and lower gastrointestinal tract in ESRD patients.