The high incidence of cardiac and vascular disease in maintenance hemodialysis (MHD) patients has heightened interest in many investigations concerning the serum lipid levels of these patients. The prevalence and laboratory characteristics of serum lipid concentrations in MHD patients, however, are far from clear. We hypothesized that serum lipids are significantly lower in MHD patients compared to their matched nondialysis counterparts. We compared 2-year averaged serum levels of total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoproteins (HDL), and triglycerides in 285 MHD patients to the same averaged measurements during the same period of time in 285 nondialyzed outpatients from the same geographic area, whose lipid panels were measured in the same laboratory. Matching factors were sex, race and/or ethnicity, diabetes mellitus, and age (+/- 5 years). The MHD patients and their matched controls were 55.6 +/- 13.5 (SD) and 56.3 +/- 13.0 years old, respectively. Each group contained 51% women, 31% African Americans, 52% Hispanics, and 37% diabetics; 16% of MHD patients and 38% of controls were receiving statins. Body mass index (BMI) was significantly lower in MHD patients than in controls (26.2 vs. 31.5 kg/m2; p < 0.001). Serum cholesterol levels were significantly lower in MHD patients than in control subjects including after adjustment for BMI and statin use (TC, -51; LDL, -39; and HDL, -10 mg/dL; p < 0.001). Using conditional logistic regression for matched data and after controlling for BMI and statins, all odds ratios for predetermined hypercholesterolemic, but not hypertriglyceridemic, levels were significantly and substantially lower than 1.00, indicating much lower likelihood of hypercholesterolemia in MHD patients. Total and LDL hypercholesterolemia, although very common in nondialysis ambulatory outpatients, are substantially less prevalent in the MHD population, whereas hypertriglyceridemia is approximately equally prevalent between these populations.