To evaluate the role, if any, of alpha-1-ag in the pathogenesis of dislipidemia in hemodialysis patients, serum alpha-1-ag levels were measured in 31 patients during maintenance hemodialysis. The mean serum alpha-1-ag concentration was higher in the dialysis patients (117.58 +/- 36.65) than in controls (98.32 +/- 19.5) (p greater than 0.05), with an unexplained significant difference between males and females (p less than 0.01). Serum alpha-1-ag levels were above normal in 6 patients (19.3%) and below normal in no one. A further significant increase in the mean alpha-1-ag concentration was observed following a single dialysis (132.19 +/- 37.12) (p less than 0.001). No correlation with dialytic age or underlying nephropathy was noted. Serum alpha-1-ag levels did not correlate with serum triglycerides, nor was there any difference between normotriglyceridemic and hypertriglyceridemic patients. Therefore it seems unlikely that a deficit in alpha-1-ag due to uremia per se or secondary to dialysis may have a role in pathogenesis of dislipidemia in uremic patients during maintenance hemodyalysis.