<i>Background:</i> Abnormalities of the aortic valve occur with increased frequency in patients with renal failure and may contribute to the observed excess cardiovascular mortality. Little data exist on the rate at which aortic stenosis progresses in this patient group. <i>Methods:</i> A retrospective case-control study was designed to compare the rate of progression of aortic stenosis in dialysis patients with that in sex-matched controls. Dialysis patients with aortic stenosis were identified by a search of the echocardiography database. Twenty-eight dialysis patients were compared to 56 sex-matched controls, all of whom had aortic stenosis on at least two echocardiograms 6 months apart. Changes in mean and peak transvalvular gradient as well as valve area were calculated from echocardiographic data and compared. <i>Results:</i> Aortic stenosis progressed more rapidly in the dialysis patients than in the controls when measured by change in valve area (–0.19 vs. –0.07 cm²/year; p < 0.001) and change in peak transvalvular gradient (6.5 vs. 3.9 mm Hg/ year; p = 0.04). There was also a trend towards more rapid progression of mean transvalvular gradient (4.9 vs. 2.5 mm Hg/year; p = 0.052). On multivariate linear regression analysis, only end-stage renal failure (p = 0.02) and baseline valve area (p = 0.04) predicted accelerated progression of aortic stenosis. <i>Conclusions:</i> Aortic stenosis progressed more rapidly in the presence of renal failure. The time frames for review and operation in dialysis patients should be shorter than for the general population.