Uremic pericarditis that is unresponsive to intensive hemodialysis may culminate in pericardial tamponade. This complication occurred in 15 of 179 patients in long-term hemodialysis. Echocardiography was employed in 14 of 15 patients and proved to be the single most helpful diagnostic procedure. All were managed surgically, some with generous pericardiectomy, others with "pericardial window." All patients tolerated these surgical procedures well, and there were no deaths related to the surgery. Follow-up done up to four years later demonstrated that a "pericardial window" has the same efficacy as a more extensive procedure. There have been no long-term complications.