The prognostic impact of thallium(Tl)-201-dipyridamole (DPM) stress and redistribution scintigraphy done in 36 patients on chronic hemodialysis (HD) and in 23 renal transplant recipients (TRs) was evaluated according to cardiovascular complications and survival in a follow-up period of six years. Though symptomatic ischemic heart disease (IHD) was present in 33% of HD patients and in 17% of TRs, 50% and 39%, respectively, had Tl-201 findings indicative of IHD. The duration of HD treatment was similar for patients with an abnormal or normal scintigraphic finding. Abnormal Tl-201 results were seen more frequently in older patients. During follow-up, 27 of 36 HD-patients died, 16 had an abnormal and 11 a normal Tl-201-DPM finding; cardiovascular complications were the cause of death in 88% and 18% of these patients, respectively. Thus the incidence of death from fatal cardiac events was 12% per year at risk for the former and 1.9% per year at risk for the latter. In TRs survival was not different for patients with an abnormal or normal Tl-201 finding (56% vs. 64%). However, fatal or nonfatal cardiovascular events were seen more frequently in patients with an abnormal Tl-201 results (78% versus 7%; p less than 0.0001). Stepwise logistic analysis and survival analysis demonstrated Tl-201-DPM stress/redistribution scintigraphy to be the only predictor for identifying patients at increased risk for cardiovascular events. In patients with abnormal Tl-201-DPM scintigraphy subsequent survival was extended for symptomatic patients as compared to asymptomatic ones )30.3 +/- 21.6 versus 22.0 +/- 17.3 months; p less than 0.008).