Significance: Emerging risk factors for heart disease have been identified by the National Cholesterol Education Program Adult Treatment Panel III (ATP-III). Therefore the purpose of this study was to examine the relationships between HDL and the emerging risk factor of large HDL and differences in risk stratification when using ATP-III guidelines. Design: Lipid profiles were conducted on 541 End-Stage Renal Disease (ESRD) patients who were presently chronic hemodialysis patients. Lipid profiles were measured using gel electrophoresis and their particle size and concentration measured using Nuclear Magnetic Resonance (NMR) spectroscopy. Results: A Pearson correlation revealed a strong correlation between HDL cholesterol and large HDL (r2=.884, p=.0001). A one-sample Kolmogorov-Smirnov test for normality was calculated (p=0.097), revealing insufficient evidence that the distribution was not normally distributed. Using the new HDL cholesterol levels of the ATP-III report, 255 (47.1%) patients were placed in the high risk category (<40 mg/dL) and 46 (8.5%) in the low risk HDL cholesterol category (>60 mg/dL), with 240 (44.4%) not meeting either criterion. Additionally, 142 (26.2%) patients were at-risk using large LDL (>8.8-13 nm) stratification with 399 (73.8%) designated as low-risk. Conclusions: The strong correlation between HDL cholesterol and large HDL (r2=.884, p=.0001) may suggest that large HDL in this population is a good predictor of risk. But, it should be noted that though a strong correlation between HDL cholesterol and large HDL were reported, discrepancies exist when comparing the number of patients at-risk for each measure when following NCEP risk stratifications. When using the ATP-III HDL concentration guidelines as a means of risk stratification, 255 (47.1%) of ESRD patients were considered at-risk (<40mg/dL). When using the emerging risk factor of large HDL, 142 (26.25%) were identified as at-risk, identifying an additional 20.6% of ESRD patients using HDL. LDL has been identified as more predictive for CHD than HDL, but using large HDL may help to identify a smaller more targeted patient pool that are more at-risk patients and have an impact on treatment modalities when compared to HDL cholesterol alone. However, the strong correlation between HDL cholesterol and large HDL adds to the confusion of understanding risk prediction using these two variables. Yet, the specificity of large HDL may help to explain why many patients experience myocardial infarction yet have normal levels of HDL cholesterol.Keyword(s): disease prevention/wellness, research