Abstract The survival experience of 39 patients receiving long-term regular hemodialysis in Seattle since 1960 was studied with particular reference to mortality and morbidity from arteriosclerotic cardiovascular complications. Mean age (± 1 S.D.) was 37.0 ± 9.5 years for the group at the start of dialysis. Mean duration of treatment was 6.5 years (range, one to 13). Overall mortality was 56.4 per cent at the end of the 13-year follow-up period, and 14 of 23 deaths could be attributed to arteriosclerotic complications: myocardial infarction was responsible for eight, strokes for three, and refractory congestive heart failure for three deaths. The incidence of these complications was many times higher than for normal and hypertensive groups of comparable age, and similar to rates found in Type 2 hyperlipoproteinemia. These results indicate that accelerated atherosclerosis is a major risk to long-term survivors on maintenance hemodialysis. (N Engl J Med 290:697–701, 1974)