The patient with post-traumatic acute renal failure (PTARF) secondary to combat injuries is generally one who is gravely ill, irrespective of the concomitant development of acute renal failure. Most have multiple wounds from exploded fragments or serious gunshot wounds, crush injuries, or severe burns from napalm or phosphorous. Many have had shock for variable periods of time, multiple transfusions with frequent minor or major reactions, nephrotoxic antibiotics, contaminated wounds with secondary sepsis and metastatic infection, frequent hyperbilirubinemia due to intrahepatic cholestasis, and bleeding with DIC, presumably secondary to Gram-negative sepsis. Death in these patients may be related to the primary injury and protracted shock; to the consequent effects of sepsis and infection in insufficiently debrided tissues; to hyperkalemia (as a result of massive tissue distruction, lysis of transfused red cells, the concomitant effects of acidosis and undernutrition resulting in shifts of potassium from, and decreased re-entry into tissues, or decreased urinary potassium excretion from renal underperfusion or frank renal failure); or may be the result of renal failure and uremia. As pointed out by Meroney, 16 the early rapid rise in serum potassium often reflects tissue necrosis and inadequate debridement, rather than renal failure per se, and is both an indicator of the need for more extensive surgical treatment and an index of a fatal outcome if not approrpriately attended. Regardless of the cause, the combat casualty whose wounds are associated with renal failure continues to be at high risk of death. There has been no real improvement in survival in these individuals, since the original institution of hemodialysis in close proximi~ to the battle front in 1951 during the Korean Conflict. 2 This would seem