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Increased levels of pancreatic enzymes have been reported in patients with renal insufficiency and ascribed either to impaired urinary excretion or, in a few studies, to the presence of pancreatic damage. In the present study serum total amylase, pancreatic amylase, and lipase were evaluated in 63 patients with chronic renal insufficiency (CRF), in 98 patients on hemodialysis (HD), in 28 patients on continuous ambulatory peritoneal dialysis (CAPD), in 23 patients with renal transplantation (RT), and in 34 normal volunteers (C). Serum parathyroid hormone and triglyceride levels were also measured in the majority of patients. Ultrasound examination of the pancreas was performed in a select number of cases. Mean values of pancreatic enzymes were significantly higher in all the study groups in comparison with controls, but values exceeding three times the upper normal limit were detected only in HD patients, who also showed amylase and lipase levels significantly highly than those of CAPD and CRF subjects. Negligible amounts of pancreatic enzymes were detected in peritoneal fluid of CAPD patients. Significant correlations were found with serum creatinine in CRF, with parathyroid hormone in HD and CAPD, and with duration of treatment in HD. No pancreatic abnormalities were detected by ultrasound. In conclusion, very high levels of pancreatic enzymes are seen mainly in HD patients and might be related more to the metabolic derangement of long-term dialysis treatment than to the occurrence of acute pancreatic damage.