Since 1965, 330 patients have received chronic dialysis treatment at the Nashville VA Hospital. Home hemodialysis training was established in 1968, and a unique class format has been used since 1970. Despite the national trend of fewer patients beginning home dialysis each year, more than 50 percent of our patients have chosen this form of therapy yearly since 1969. A total of 182 patients (55 percent) from 15 states have completed home training with an attrition rate of only 8 percent. Mean distance of patients' homes from the training center is 185 miles. Five-year survival for home hemodialysis patients is 91 percent, compared to 59 percent and 55 percent for patients receiving renal transplant and center dialysis, respectively. Seventeen deaths have occurred in home dialysis patients, half of which were due to cardiovascular disease. Home dialysis offers an excellent mode of therapy for patients with chronic renal failure and probably is particularly suitable for patients over 50 years of age.