Nephrologists as primary care providers: A review of the issues

Jean L. Holley

Research output: Contribution to journalArticlepeer-review


Considering the role of nephrologists as primary care providers for their chronic dialysis patients requires exploration of a number of factors. These factors include the definition of a primary care provider, the time and expertise needed to provide primary care, the expectations of nephrologists and dialysis patients who give and receive primary care, the appropriate preventive care for end-stage renal disease (ESRD) patients, and the current and future roles of nephrologists within a changing health care environment. Unfortunately, few studies have addressed these issues, and there is little objective information on which to base guidelines and recommendations about nephrologist-directed primary care of ESRD patients. Most nephrologists spend a significant portion (30% to 35%) of their time caring for dialysis patients, and 90% report providing primary care to dialysis patients. Most dialysis patients view their nephrologist as their primary care provider. The increasingly aged and III ESRD population will undoubtedly necessitate additional time and expertise for care from an understaffed nephrology work force. The increased use of advanced practice nurses and alliances with health care delivery systems under global capitation program may develop into effective strategies to provide care for an increasing population dialysis patients. The nonnephrologic health care needs, including specific and appropriate cancer screening and preventive health care protocols for ESRD patients whose life expectancies are significantly less than the general population, are unclear. The issues involved in considering nephrologists as primary caregivers for ESRD patients include these and other related factors, and will be discussed in this review.

Original languageEnglish (US)
Pages (from-to)574-583
Number of pages10
JournalAmerican Journal of Kidney Diseases
Issue number4
StatePublished - Apr 1998
Externally publishedYes


  • Cancer screening
  • Dialysis
  • ESRD
  • Preventive care

ASJC Scopus subject areas

  • Nephrology


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