The frequency of radiological changes of the bones of the hand in 142 patients on hemodialysis, 19 on CAPD, and 15 patients with advanced renal insufficiency not requiring dialysis was analyzed. Forty-seven percent of all patients had subperiostal cortical bone resorptions, 31 % periarthritis calcarea, 22 % periarticular erosions, 3 % chondrocalcinosis and 1 % aseptic necrosis. Sixty-six percent of the periarticular erosions were observed in the distal and proximal interphalangeal joints of fingers II, III, IV and V, whereas only 33% were found in the remaining joints (120 vs. 62, p < 0.001). The distal interphalangeal joints showed about 70% more often periarticular erosions than the proximal interphalangeal joints (77 vs. 43, p < 0.001). Since patients with chronic renal failure exhibit a decreasing incidence of periarticular erosions from the distal interphalangeal joints to the intercarpal joints, while patients with rheumatoid arthritis have their erosions preferentially localized in the proximal interphalangeal, meta-carpophalangeal and wrist joints, it can be concluded that renal osteodystrophy causes a distinct distribution of periarticular erosions of the bones of the hand.