The Royal Perth Hospital provides access to dialysis treatment to Indigenous Australians living in remote areas of Western Australia who are suffering from end-stage renal disease (ESRD). The Remote Area Dialysis Programme (RADP), established in 1989, relocated traditional hospital services to remote communities and introduced home or community-based therapy. This unique state-wide programme was developed in cooperation with tribal elders in Aboriginal communities, and regional medical, nursing and community health staff. Prior to RADP's establishment, these patients faced the choice of permanent relocation to Perth for dialysis treatment or death from renal failure. Development of the RADP allowed Indigenous patients with ESRD to receive dialysis treatment in their own home/community. Requirements for home haemodialysis include establishing the suitability and capability of patients, the availability of carers and an appropriate home or community environment for dialysis machine installation. This has required novel strategies to address cultural and language impediments to home therapy. The remoteness of some isolated communities has been a technical challenge for the dialysis technicians due to the uncertainty of power supply, climatic extremes and inadequate supply or poor quality of water. A specific training program has been developed to adapt to the needs of Aboriginal patients. Patients undertaking home haemodialysis face many challenges and a number of initiatives will need to be implemented to ensure the ongoing success of the programme.