During the past five years we have tried to offer hemodialysis or transplantation or both to all patients who presented with chronic renal failure in our geographical region. Our initial estimates indicated that approximately 350 patients (175 per million population) yearly would progress into the terminal stages of their kidney disease in the intermountain region. Fortunately, from our more recent experience the number appears to be less than 150 cases (75 per million) per year. The patients were accepted according to their need for treatment, except to exclude those with malignancies, with severe disease in other organ systems than the kidney, and those of advanced age.
Having the alternatives of hemodialysis or transplantation offered several advantages to the patients. Those who chose transplantation could fall back upon dialysis if their graft failed; those who developed peripheral neuropathy or other complications on dialysis could be shifted to transplantation. A vigorous program