Screening and preventive health practices for the end-stage renal disease patient

The population of end-stage renal disease (ESRD) patients continues to grow and to age. The nephrologist often is the sole or principal physician responsible for the total management of these patients. In this role, the nephrologist must address issues of routine health maintenance. Screening tests and preventive care should be continued to detect, prevent, or minimize comorbid conditions that could affect quality of life or survival. Effective primary and secondary prevention requires understanding the principles of screening tests and their appropriate use. Screening and counseling procedures recommended for healthy adults should be continued, although certain screening tests may appropriately be discontinued if the expected survival is 5 years or less. Secondary prevention for cardiovascular disease is particularly important in ESRD patients, in whom accelerated atherosclerosis is often the cause of morbidity and death. Aggressive counseling in smoking cessation and in management of hyperlipidemia should be undertaken, in the hopes of limiting this common comorbidity.