THE number of patients undergoing treatment for end-stage renal disease (ESRD) has increased dramatically since 1973, when Medicare began funding its treatment. Federal support has made dialysis and transplantation available to all patients, including the economically disadvantaged, who previously had difficulty obtaining financial support for these expensive types of treatment. Since then, the number of patients entering ESRD programs has greatly exceeded the original estimates formulated in 19671 and is now much greater than the number of patients undergoing treatment for ESRD in the most economically and technologically advanced countries of Europe.2 The reasons for this are uncertain. Relman and. © 1982, Massachusetts Medical Society. All rights reserved.