Background: NT-proBNP is a well known marker of congestive heart failure (CHF). However, ESRD patients have quite higher levels than patients with normal renal function. Methods: We investigated NT-pro-BNP levels in 366 chronic dialysis patients [On-D group; hemodialysis (HD), n=298; peritoneal dialysis (PD), n=68] and 174 stage V chronic kidney disease [creatinine clearance (ClCr) <15 mL/min/1.73m2] patients who had not started dialysis (Non-D group). Results: ClCr levels of On-D and Non-D groups were comparable (10.63짹4.45 mL/min/1.73m2 vs. 10.18짹3.46 mL/min/1.73m2, p=0.243), but NT-proBNP level was significantly higher in On-D group than in Non-D group (25,035짹12,554 pg/mL vs. 17,898짹13,853 pg/mL, p<0.001). Among On-D group patients, HD patients showed higher NT-proBNP levels than PD patients (25,707짹12,148 pg/mL vs. 22,261짹13,843 pg/mL, p=0.041). Patients presenting CHF (n=171, 31.7%, 29,620짹9,485 pg/mL) showed higher NT-proBNP than those without CHF (n=369, 68.3%, 19,374짹13,740 pg/mL, p<0.001). However, in subgroup analysis according to presenting with or without CHF (CHF and non-CHF subgroups), NT-proBNP levels were not different according to dialysis modality (CHF subgroup, HD, 32,277짹6,554 pg/mL vs. PD, 33,162짹5,486 pg/mL, p=0.645; non-CHF subgroup, HD, 22,877짹12,908 pg/mL vs. PD, 19,925짹13,998 pg/mL, p=0.137). Conclusion: Although NT-proBNP is a marker of CHF in patients with ESRD, NT-proBNP levels are different according to whether or not on dialysis, dialysis modality, and clinical presentation in ESRD patients. It should be kept in mind in interpretation of NT-proBNP levels in this population.