Seven patients undergoing repetitive dialysis died following a course of progressive cachexia associated with unexplained ascites. Uncontrolled hypertension was present in all seven, but blood pressure showed a tendency to fall as cachexia became prominent. Hypotensive episodes were a common severe complication during the dialysis procedure. Seven similar patients with hypertension and cachexia, three of whom had unexplained ascites, have undergone binephrectomy for the primary control of hypertension (one patient) and attempted improvement of the cachectic process (six patients). Postoperative clinical condition has improved remarkably in all, as manifested by a gain of real body weight, increased strength, reduction of blood pressure, and disappearance of ascites. Although anephric and somewhat more anemic, these patients have not required any changes in the amount of blood transfused. The salutary results of binephrectomy on cachexia, ascites, and hypertension suggest a causative relationship.