Pragmatic realities in uremia therapy.

The present status and future prospects of uremia therapy in the United States are reviewed. Approximately 3500 renal transplants were done in 1976 as compared to 3700 in 1975. Functional two-year survival of grafts has not changed recently (40 to 45 per cent for cadaver donors; 70 to 75 per cent for siblings), but patient survival with cadaver grafts continues to improve (now 65 per cent at two years). Patients on hemodialysis in facilities are increasing rapidly. Only 13 per cent are on home dialysis, as compared with nearly 40 per cent five years ago. Home patients do at least as well as those in centers (80 per cent two-year survival) and cost 40 per cent less. Physician bias probably explains the trend to center dialysis, but pending legislation may provide new incentives for home treatment. Prospects for technical advances are good, but a greater federal investment in research and development is needed. Dollars saved on the center dialysis could be used for this purpose.