Endocrine-metabolic disturbances of renal failure have many underlying mechanisms, including abnormal secretion, transport, and target cell binding, impaired synthesis and elimination by the diseased kidney, and responses to stimuli resulting from altered homeostasis. Neither hemodialysis nor continuous ambulatory peritoneal dialysis (CAPD) removes large amounts of hormones. By correcting metabolic, fluid and electrolyte disturbances, dialysis may improve some endocrine abnormalities. Possibly because of more permeable membranes, or continuous treatment including ultrafiltration, CAPD has a somewhat more salutary effect on uremic endocrinopathy than hemodialysis. In particular, hormonal regulation of salt and water balance, erythropoietic function, female reproductive function, and some aspects of renal osteodystrophy respond more favorably to CAPD. The endocrine response suggests that there is no inferiority of CAPD as a treatment for renal failure.