OBJECTIVE To determine prevalence of renal cell carcinoma in a cohort of patients with end stage renal disease who underwent nephrectomies for suspicious cysts or masses. METHODS A retrospective review of patients with end stage renal disease who were receiving hemodialysis and underwent nephrectomies were identified and those charts were reviewed. RESULTS Twenty patients, from a total of 400 patients with end stage renal disease, had nephrectómies preformed for various reasons. Of these twenty patients, four were found to have renal cell carcinoma with an occurrence rate of 5% in these patients. At followup from 1-9 years, all patients are alive without evidence of disease. CONCLUSIONS Patients with end stage renal disease have an increased prevalence of renal cell carcinoma. While the patients in this series have a 100% survival at 1-9 year follow-up, the overall survival rate in published reports is 35%. The need is to identify patients at high risk for the development of this disease and perform annual screening.