Many recent reports warn of the increasing burden of end-stage renal disease projected in the coming years. A related concern is the attendant complications of hemodialysis, such as bacteremia, and most importantly, the episodes of infective endocarditis that can result from these infections. The available data involving the incidence, valvular distribution, and outcomes are either dated or based on studies with cohorts of, at most, 20 patients. In this retrospective study, data were obtained from medical records of the largest cohort of patients with "definite endocarditis" to date, with a large representation of patients using an arterial-venous fistula for vascular access. The overall mortality of patients in this cohort was 53%, the mitral valve was most commonly affected, and Staphylococcus aureus was identified as the causative organism in 50% of the patients. Despite improved diagnostic maneuvers, more standardized antibiotic therapy, and more sophisticated valve replacement, the mortality of infective endocarditis in end-stage renal disease remains high, and more work is needed to improve outcomes of this potentially lethal complication.