One hundred one patients established on chronic hemodialysis on January 1, 1978, were retrospectively evaluated over the ensuing 8-year period to determine the effect of hepatitis B surface antigenemia on morbidity and mortality. Sixty-four patients remained HBsAg-negative after reaching end-stage renal disease; 30 were transiently or persistently HBsAg-positive; seven patients were excluded from study because of insufficient data. The HBsAg-positive and HBsAg-negative patients did not differ with respect to age, sex, race, or etiology of renal disease. There were no differences between the positive and negative groups in terms of death rates (50% v 34.4%, P = not significant), causes of death, hospitalizations (1.5 v 1.2/patient/yr), or hospitalized days (18.0 v 11.8 patient/yr). Only mild liver enzyme elevation (SGOT) was observed at the time of conversion in 13 patients with enzyme abnormalities who seroconverted after beginning hemodialysis (mean SGOT 255 micron/mL). No patient had persistent liver enzyme elevation over the 8-year period. These data suggest that chronic hepatitis B surface antigenemia is not, in itself, associated with increased morbidity or mortality in a chronic hemodialysis population.