Effects of medical advances and political climate upon psychonephrology

Two relatively recent medical advances have enlarged the options open to patients with renal failure. Continuous ambulatory peritoneal dialysis (CAPD), a form of home care that does not utilize the circulatory system, offers an alternative to those with vessel access compromise. Cyclosporine, a new, but expensive immunosuppressant, has substantially improved chances of success of renal transplantation. However, on the negative side, the federal government has attempted to diminish its expenditure in support of treatment of renal failure by favoring less costly modalities and diminishing its reimbursement of physicians and facilities. Patients are pressured into less expensive forms of treatment, such as CAPD and home hemodialysis, at times with little regard for individual needs. Diminished reimbursement places a greater financial burden upon not-for-profit centers over those that are proprietary.