OBJECTIVE: More patients are reaching end-stage kidney disease without evident cause. This study aims to explore occupational risk factors associated with hemodialysis. METHODS: A multicenter matched case-control study included dialysis patients and age, sex, and diabetes-matched controls (normal kidney function). Conditional logistic regression analysis assessed occupational factors associated with dialysis. RESULTS: Two hundred thirty eight hemodialysis patients and 238 controls were included. History of occupational heat exposure (odds ratio [OR] = 1.93; 95% confidence interval [CI]: 1.24 to 3.00), working as a cook (OR = 12; 95% CI: 1.56 to 92.29), as construction worker (OR = 10; 95% CI: 1.28 to 78.12) were associated with higher risk of dialysis. These results were significant in men and in those with kidney disease of unknown etiology. CONCLUSIONS: Occupational heat exposure was found to be associated with hemodialysis. This is an important step for future development of preventive strategies in high-risk professions.