Abstract Hypothermia is defined as a core body temperature of less than 35[deg ]C and is divided further into mild, moderate, and severe depending on the temperature level. Several active internal rewarming modalities have been described in the management of moderate-to-severe accidental hypothermia. We report a 73-year-old black man with underlying end-stage renal failure and ischemic cardiomyopathy who was admitted with severe accidental hypothermia (core body temperature, 24.9[deg ]C) secondary to environmental cold exposure. The patient was resuscitated initially with warm intravenous fluids and peritoneal dialysis with warm fluids with an average temperature rise of 1[deg ]C. The patient was switched to hemodialysis that brought his temperature from 30.2[deg ]C to 36.7[deg ]C during a 3.5-hour dialysis with an average rise of 1.9[deg ]C/h. Hemodialysis is a rapid and efficient modality of rapid internal rewarming for moderate-to-severe accidental hypothermia. [copy ] 2001 by the National Kidney Foundation, Inc.