Nephrology

Maintenance dialysis in the major form of renal replacement therapy for patients with end-stage renal disease. In the United States, more than 150 000 patients with end-stage renal disease are treated with hemodialysis or peritoneal dialysis per year, at a cost in excess of $5 billion per year. Despite all the scientific progress and the huge public financial investment that made dialysis therapy available to all patients with end-stage renal disease, the mortality among American dialysis patients is significantly higher than among European or Japanese patients.1Indeed, the 5-year survival for patients who began their hemodialysis therapy during 1982 through 1987 is 40% in America, 59% in Europe, and 61% in Japan.1,2 Several factors may be responsible for this difference, including the preponderance of diabetes among American dialysis patients (27% vs 19% in Japan and 10% in Europe) and differences in mortality in the general population, age distribution