In the present review, the role of lipid disturbances is evaluated as a risk factor in the pathogenesis and the potential acceleration of atherosclerosis in uremic patients undergoing long-term hemodialysis. The alteration in high density lipoprotein composition with a decrease in high density lipoprotein cholesterol but a normal apoprotein AI content may have relevance to the atherogenetic process. Moreover, the accumulation of cholesterol-rich, very low density lipoproteins and intermediate density lipoproteins may play a major role in atherosclerosis since these degradation products of triglyceride-rich particles are considered as atherogenic. The hypothesis should be tested whether a correction of the abnormal catabolism of triglyceride-rich lipoproteins in uremic patients leads to a decrease in ischemic vascular events.