d mortality. Maintenance hemodialysis has been recognized since 1961 as a means by which ESRD patients may be kept alive indefinitely. The federal end-stage renal disease program is more than 20 years old. In fact, Medicare currently covers almost all aspects of dialysis patient care (Paganini, 1992, p. 12). By 1990, over 200,000 patients were being treated for ESRD. The 1-year mortality rate in the United States throughout much of the 1980s was around 25%. In 1990, however, the rate was down to 21.2%. Various studies have additionally reported that 5-year dialysis patient survival rates are between about 60% and 70%; the 10-year average survival rate is in the 50-60% range (Lundin III, 1985, pp. 35-40). Most patients who begin dialysis are between the ages of 30 and 40 years. Mortality tends to increase with age; it is also higher among males and diabetics. Just some of the complications thought to be responsible for hemodialysis mortality include the following: (1) the exhaustion of vascular access sites; (2) progr
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