Author Affiliation: Lakeside Nephrology, Chicago, Illinois.
Less Is More is a great concept, and recent evidence suggests that the aggressive provision of erythropoiesis-stimulating agents and earlier dialysis no longer appear tenable. However, we should not throw out the baby (ie, earlier referral to nephrologists) with the bath water. The observations of Winkelmayer et al1 were important, but I do not believe the authors intended to send a message that early renal referrals of patients with chronic kidney disease (CKD) is unnecessary.
Hirsch S. A Defense of Early Renal Referral: Preventing Progression to End-Stage Renal Disease. Arch Intern Med. 2011;171(22):2064-2065. doi:10.1001/archinternmed.2011.584