Pancreatic exocrine insufficiency in patients with end-stage renal disease on hemodialysis is not well documented despite the prevalence of a wasting syndrome, which may indicate pancreatic involvement. The present study intended to evaluate pancreatic exocrine function in this group. Eight patients were studied, none of whom had a history suggestive of pancreatic exocrine involvement. Routine 72-h stool collection was performed, and estimation for fecal fat showed steatorrhea in four patients. The secretin-pancreozymin test (direct stimulatory method) showed a statistically significant decrease in amylase and lipase levels in the duodenal aspirate, and increased basal and stimulated serum amylase (p less than 0.05). Values for volume, bicarbonate, and trypsin in the aspirate were normal. The role of pancreatic hypofunction in the etiology of the wasting syndrome of end-stage renal disease is therefore considered, as well as the advantages of pancreatic supplementation in improving nutritional status.