Improving outcomes in CKD and ESRD patients: Carrying the torch from training to practice

Allen R. Nissenson, Rajiv Agarwal, Michael Allon, Alfred K. Cheung, William Clark, Tom Depner, Jose A. Diaz-Buxo, Carl Kjellstrand, Alan Kliger, Kevin J. Martin, Keith Norris, Richard Ward, Jay Wish

Research output: Contribution to journalReview article

13 Scopus citations


Practicing nephrologists are spending more time caring for end-stage renal disease (ESRD) and chronic kidney disease (CKD) patients. Despite this focus, and considerable advances in the understanding of those aspects of care that impact on clinical outcomes, morbidity, mortality, and quality of life for these patients has not improved substantially over the past decade. One of the possible explanations for this lack of progress is the structure of current nephrology training programs, where ESRD and CKD patient care is not emphasized. To address this issue, we developed a short preceptorship for second-year nephrology fellows, including didactic lectures and workshops. Of 67 participating fellows, 50% were from programs offering 3 or fewer months of exposure to outpatient hemodialysis, and 25% reported no exposure to peritoneal dialysis. Of more concern, 25% reported no "official rounds" with an attending nephrologist on dialysis patients. If nephrologists are to take their appropriate place as leaders of the care delivery team, nephrology fellowships must be restructured with appropriate emphasis placed on the comprehensive care of ESRD and CKD patients.

Original languageEnglish (US)
Pages (from-to)380-397
Number of pages18
JournalSeminars in Dialysis
Issue number5
StatePublished - Sep 1 2004


ASJC Scopus subject areas

  • Nephrology

Cite this

Nissenson, A. R., Agarwal, R., Allon, M., Cheung, A. K., Clark, W., Depner, T., Diaz-Buxo, J. A., Kjellstrand, C., Kliger, A., Martin, K. J., Norris, K., Ward, R., & Wish, J. (2004). Improving outcomes in CKD and ESRD patients: Carrying the torch from training to practice. Seminars in Dialysis, 17(5), 380-397.