The role of the nephrologist in ESRD/Pre-ESRD care: a collaborative approach

The number of patients with chronic renal failure and end-stage renal disease continues to increase. Nonetheless, there are increasing pressures to decrease the number of nephrologists. To provide highly specialized care for these complex patients, nephrologists must render less care for more patients, or allow less qualified providers to render care. Use of a highly specialized professional colleague, the properly trained nephrology nurse practitioner, allows the nephrologist to provide care for a great number of patients while maintaining quality using an integrated collaborative practice model. This article describes the successful use of nurse practitioners to extend the scope of nephrology care with this paradigm. This model allows the nephrologist to provide specialized care to more patients, maintain quality control, improve cost effectiveness of care rendered, and is enthusiastically embraced by the patients cared for by the team.