Hemodialysis carried out in special facilities is, if not threatened, at least slipping a bit from its position as the dominant mode of therapy for patients with end-stage renal disease. The most remarkable single change, occurring within the last three years, has been the increased number of patients using continuous ambulatory peritoneal dialysis (CAPD).
At the recent Controversies in 1981 Nephrology meeting held in Arlington, Va, participants debated the safety and efficacy of CAPD with respect to various patient groups. There were strong warnings that economic and political factors will favor home dialysis in the future, but within that context, some nephrologists are still unconvinced that CAPD is as safe and effective as hemodialysis.
Since hemodialysis was brought under Medicare coverage by federal legislation in 1972, the impact on nephrology has been tremendous. Administered by the Health Care Financing Administration (HCFA), Medicare's End-Stage Renal Disease Program has paid 80% of