Although long-term hemodialysis successfully controls uremia in end-stage kidney failure, the process is nevertheless beset with various complications. Among the worst, about which Feingold et al write in the December issue of Archives of Internal Medicine (134:989, 1974), is progressive cachexia usually accompanied by ascites.
Early in the experience of their hemodialysis program, the authors observed seven patients (group 1) who died following a course characterized by progressive cachexia, ascites, hypertension, and a tendency to severe hypotension during dialysis. The primary change in the kidneys of all but two of the patients was arterial and arteriolar nephrosclerosis. The other two patients had old glomerulonephritis, severe interstitial nephritis, and severe arteriolar nephrosclerosis.
Seven similar patients (group 2), observed later in the authors' experience, underwent bilateral nephrectomy. Body weight had fallen appreciably in all but one patient who was already cachectic. Three patients had ascites, and all had had hypertension, uncontrollable until