The reports on surgical techniques that specifically focus on the management and outcome of patients on chronic hemodialysis (CHD) who undergo major intra-abdominal procedures--particularly of an emergency nature--are few. It is hoped that by analysis of our experience the nature of the problem can be further clarified and guidelines for clinical care can be formulated. Thirty-two cases which encompass a 7-year period (1978 to 1985), were reviewed. Seventeen patients underwent elective surgery and fifteen underwent emergency intervention. There was a wide range of cases that were similar to those most generally seen in an acute-care teaching hospital. The morbidity and mortality rates in elective surgery patients were 12% and 6%, respectively, while in the emergency cases, these rates were 62% and 47%. Patients with diabetes had the highest morbidity and mortality. These results were analyzed, and we conclude that CHD patients at risk with a surgically correctable condition should be considered for elective intervention, even if they are currently free of symptoms. This may be particularly true for CHD patients with diabetes.