Thanks so much for this article. My biggest frustration as a primary care NP in treating ESRD patients is that once they are on dialysis, the nephrologists stop communicating with us. A note every 6 months, plus a copy of recent labs, would be very helpful, so that we know what is going on with the patient. They seem to forget that we have treated the patients for years while their kidney function was better than it is now. I recently saw a dialysis patient, who is doing well. But I found out he had had a lot of trouble with the vasculature in his access arm and had multiple procedures, consults, etc. Keeping our practice "in the loop" would have been appreciated and I would have called him to touch base. That said, I am extremely cautious in what I prescribe for these patients and if I have any question that I can't find the answer to, I call the nephro. Better safe than sorry.