Serial macroradiographs of the hands of 80 patients on maintenance hemodialysis were reviewed to assess the frequency and distribution of articular and periarticular erosions. Articular and periarticular erosions are common and were demonstrated in 24 (30%) of 80 patients. The pattern and distribution of the erosions are unlikely to be confused with any of the well known erosive arthropathies except in an unusual circumstance. The presence and severity of the erosions do not correlate with the severity of subperiosteal resorption of the middle phalanges and in several instances were accompanied only with resorption of the phalangeal tufts. The erosions may progress with time, but do not seem to have any bearing on clinical symptoms. In no instance did the erosions disappear after removal of parathyroid adenomas. Recognition of the frequency of these erosions broadens the spectrum of skeletal changes found in azotemic osteodystrophy, but does not in any way warrant further investigation since they are clin...