The Canadian Organ Replacement Register annual report (1998) provides insightful trends in renal replacement treatment modalities, comparing data from 1981 to 1996. The purpose of reviewing this report was to look at the scope of change over time in the distribution of treatment modalities and Canadian patient demographics: age, gender, dwelling (alternate care facilities, home and in-hospital), and medical conditions (vascular access, communicable diseases, diagnosis, and cause of death). Discussion focuses on the impact of these and other changes in the practice setting and describes the Canadian Association of Nephrology Nurses and Technologists' (CANNT) initiatives to support nephrology nurses and technologists.