Vanadium (V) has been reported to inhibit a number of enzyme activities such as those of Na(+)-K(+)-ATPase. The main excretory pathway of this element is via the kidney. These facts led us to study the V distribution in uremic patients. As a result, hemodialysis patients at our dialysis center exhibited extremely high levels of serum V (23.9 +/- 11.3 ng/ml, n = 43) as compared with healthy adults. Nondialysis patients did not show increased serum V concentrations. The V contents were significantly elevated in the skin and in the aortae of hemodialysis patients. It was found that the tap water from Kanagawa prefecture, Japan, had the highest V concentrations among the 21 cities in Japan and the US. In conclusion, oral ingestion of V-contaminated water has likely caused an accumulation of the metal in patients with end-stage renal failure.