Patients who have end-stage renal disease have an acquired platelet dysfunction that leads to prolonged bleeding time and that may put them at risk for bleeding. This platelet dysfunction is manifest in reduced platelet adhesion and impaired platelet aggregation. As a result, a bleeding tendency exists in end-stage renal disease, and understandably deep vein thrombosis is vanishingly rare in patients with this condition. We present three end-stage renal disease patients undergoing maintenance hemodialysis who developed deep vein thrombosis. These cases illustrate that in some patients with end-stage renal disease, the pro thrombotic forces may be so profound that they overwhelm the bleeding tendency.