Carbohydrate metabolism was studied during a 72-hr fast in 11 nondiabetic endstage renal disease (ESRD) patients on chronic hemodialysis and six normal subjects. Blood was obtained every 12 hr for metabolic substrate, insulin, and potassium concentrations. Serum potassium concentrations were significantly higher in the ESRD patients at the end of each fasting day, and two patients were removed before completion of the fast when severe hyperkalemia developed. Mean blood glucose, alanine, pyruvate, β-hydroxybutyrate, and serum insulin concentration were similar in the two groups. Mean blood lactate concentration tended to be higher in the ESRD group. Mean blood acetoacetate and plasma free fatty acid (FFA) concentrations were lower in the ESRD group. When compared to serum insulin levels, the FFA concentration was lower in the ESRD group.