Aims: Gastrointestinal (GI) symptoms are said to be common in patients with end-stage renal disease (ESRD) and there are reports of prevalence rates as high as 79%. The aims of this study were to determine the prevalence of gastrointestinal symptoms and quality of life in patients with ESRD undergoing hemodialysis (HD) treatment in South Korea. Patients and Methods: A total of 109 patients with ESRD undergoing HD in Chung-Ang University Hospital were asked to complete a locally validated GERD questionnaire (heartburn or acid regurgitation at least once a week) and Rome III questionnaire for functional dyspepsia (FD), irritable bowel syndrome (IBS), and functional constipation (FC). The same questionnaire was also administered to ageand gender-matched 500 health check-up subjects without renal failure as controls. Patients on HD and health check-up subjects also completed the Beck's Depression Scale and the SF-36 questionnaire for health related quality of life (HRQOL). Results: The mean age (56.2±13.9 in HD vs 54.1±13.8 in controls) and sex ratio (M:F; 1.6:1 in HD vs 1.4:1 in controls) were not different between the two groups. The symptoms consistent with GERD, FC, and Depression were more common in patients with HD (13.8%, 31.2%, and 25.0%) than in controls (7.4%, 12.0%, and 8.3%) (p<0.01). The frequencies of FD and IBS were not different between in patients with HD (31.2% and 7.3%) and in controls (24.2% and 8.2%). The patients with HD were more likely to have nausea, vomiting, sense of incomplete of evacuation and straining. However, loose stool was more common in controls and the frequencies of the other symptoms such as dysphasia, odynophasia, globus, early satiation, postprandial fullness, epigastric pain, abdominal discomfort were not different between the two groups. The overall mean values of SF-36 (62.1±17.1 in HD vs 76.6±17.0 in controls) as well as each score of 5 domains among 8 domains of SF-36 (physical functioning, social functioning, role physical, vitality, and general health) were significantly lower in patients with HD than in controls. Among patients with HD, the overall mean values and each score of SF-36 domains were similar regardless of gastrointestinal symptoms, but were significantly reduced in patients with depression compared those in patients without depression. Conclusions: In patients with ESRD undergoing HD, GERD, FC, and depression were more common and HRQOL significantly reduced compared with health check-up subjects without renal failure. Among ESRD patients with HD, HRQOL appeared not to be related to GI symptoms but to depression.