The future of end-stage renal disease care: nephrology enters a new millennium

There are many challenges facing the discipline of nephrology as we enter the next millennium. There will be a continuing increase in the number of patients requiring renal replacement therapy, with older, sicker patients predominating. At the same time the available workforce to provide care to these patients is not growing quickly enough to keep up with the demand. In the broader health care delivery system, consolidation of services, vertical and horizontal integration, a continued move to for-profit entities, and constant pressure on cost containment will increasingly characterize the immediate future. The rapidity with which health care delivery and financing are changing will make it difficult for patients and health care professionals alike, but it will also offer opportunities. In nephrology, development of a collaborative model of care has already begun and will be an important part of the response to this changing care environment. Collaborative care and the application of the principles of chronic disease management to renal patients will provide the best opportunities to capitalize on new technologies and treatments as they become available and to streamline and improve the care delivery process. This should lead to improved quality of care for renal patients, while constraining costs and providing for continued professional growth and satisfaction.