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Treatment options in patients with end-stage renal disease (ESRD) and renal cell carcinoma (RCC) are limited [1]. There is very limited experience with tyrosine kinase inhibitors (TKIs) in ESRD. Both sorafenib and sunitinib are eliminated by hepatic metabolism and are thus a potential option. We report the case of a patient with ESRD on chronic hemodialysis who was successfully treated with sorafenib for mRCC. A 69-yr-old male in good physical and mental condition presented with pulmonary and mediast-inal metastases 2 yr after bilateral partial nephrec-tomy (PN) had been performed for RCC (pT3a pN0 cM0 G3) on one side and a hydronephritic hemi-kidney in a double kidney on the other side. Following the bilateral procedures, the patient had developed ESRD and was on chronic hemodialysis three times per week. Immunotherapy with inter-feron-a (INF-a; 10 million IU subcutaneously [sc] three times weekly) was poorly tolerated. Restaging after 8 wk of treatment showed progressive pul-monary metastatic disease. Additionally, a sus-pected local recurrence was seen. Sorafenib treatment was commenced with 200 mg bid and was well tolerated. After 2 wk, the dosage was increased to 400 mg bid. Grade 2 diarrhea was observed, and grade 1 hypertension developed during treatment as the only side effects. Article info Article history