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Opinion: How Should Chronic Medical Therapies be Altered with the Onset of End‐Stage Renal Disease and Initiation of Dialysis?

More than 100,000 patients start dialysis in the US each year. Most nephrologists care for patients with advancing CKD prior to starting dialysis as well as those already on dialysis, and are therefore often involved in the care of patients as they make the transition to dialysis. There is an extensive literature about the care of patients with CKD and patients on dialysis, as if these are two entirely distinct circumstances. Very little has been written about how medical therapies for adults and children making the transition from CKD to ESRD may need to be altered as residual GFR declines, and in response to the change in frequency of physician visits, the effects of dialysis, changes in diet, etc. The following articles provide views on diabetes mellitus and its management; treatment of anemia with erythropoietic stimulating agents and iron; bone and mineral metabolism, vitamin D treatment, and control of phosphorus; management of hypertension, lipid disorders, and cardiovascular disease risk; and then a variety of topics that pertain to the care of children with CKD, including nutrition and growth. More study and discussion of the transition from CKD to ESRD in both children and adults is probably warranted. —KW and JSB