The activity of intestinal isoenzyme of serum alkaline phosphatase was evaluated in 21 non-dialyzed patients with advanced renal failure and in 52 patients on regular hemodialysis. In patients without hepatopathy, a significant inverse correlation was found between the enzyme activity and serum calcium levels. Hepatopathy was the most significant variable influencing the enzyme activity in patients on dialysis. Secondary hyperparathyroidism and a decreased rate in enzyme elimination should be assessed for the above-normal activities of intestinal ALP in serum in chronic renal failure.