The term end-stage renal disease (ESRD) is used with the understanding that in this context the reference is to end-stage renal disease which requires dialysis or transplanation, as set out in the law. In correspondence with the public, it is recommended that a term such as “permanent kidney failure” be used, or “end-stage renal disease,” with the qualifying language of the law.

A process by which waste products are removed from the body by diffusion from one fluid compartment to another across a semipermeable membrane. There are two types of renal dialysis in common clinical usage, hemodialysis and peritoneal dialysis. Both hemodialysis and peritoneal dialysis are acceptable modes of treatment of chronic renal disease.

The usual periodic dialysis treatments which are given to a patient who has ESRD in order to sustain life and ameliorate uremic symptoms. Maintenance hemodialysis is generally required two to three times per week and peritoneal dialysis once per week, but less frequent treatments are sometimes adequate. In addition, greater frequency may be covered upon review of evidence which establishes medical necessity.

Dialysis given to patients who require inpatient care. (Acute dialysis may also be given to patients without ESRD because of temporary renal failure due to, for example, ingestion of certain drugs. Such conditions and treatment are not a basis for coverage under the ESRD provision.)

Regular maintenance dialysis performed by a trained patient at home or within an outpatient facility. In the case of home dialysis the patient performs dialysis with the assistance of a trained partner. In the case of “self-care” dialysis in an outpatient facility, the patient performs dialysis in a facility removed from the home, with the minimal assistance of an aide.

Dialysis given to patients under special circumstances, in a situation other than the patients' usual dialysis environment. Examples are dialysis of a home dialysis patient in a limited care unit when the patient's equipment fails, inpatient dialysis when patient illness requires more comprehensive care on an inpatient basis, and pre- and postoperative dialysis provided to transplant patients.