In selected patients, home hemodialysis offers excellent patient survival and opportunities for rehabilitation. In this article I review some survival and rehabilitation data from the literature. I then report on our experience with training 204 patients in the inner city since 1969. Cumulative technique survival is 17% at 28 years. In addition, I report the outcome of 13 patients, “long survivors,” who have been maintained on home hemodialysis for 20 or more years.