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Editor's Correspondence
Dec 12 2011

Predialysis Nephrology Care of Older Patients Approaching End-Stage Renal Disease

Author Affiliations

Author Affiliations: College of Medicine, Mayo Clinic, Rochester, Minnesota, and Luther Midelfort Site, Mayo Health System Practice-Based Research Network (MHS PBRN), and Department of Nephrology, Mayo Clinic Health System Eau Claire, Eau Claire, Wisconsin (Dr Onuigbo); and Information Technology, NTEC Solutions LLC, Eau Claire, Wisconsin (Dr Onuigbo and Ms Onuigbo).

Arch Intern Med. 2011;171(22):2066. doi:10.1001/archinternmed.2011.586

We read with great interest the recent report by Winkelmayer et al1 that demonstrated no material improvement in 1-year survival rates after dialysis initiation despite increasing predialysis care by nephrologists among 323 977 older patients initiating dialysis between 1996 and 2006.

We agree with the authors that their findings have raised very poignant questions and doubts regarding the efficacy of several costly interventions possibly provided more by nephrologists, including aggressive blood pressure lowering.1 The recent, very disappointing results of the Ongoing Telmisartan Alone and in Combination With Ramipril Global End Point Trial (ONTARGET) with combination angiotensin-converting enzyme inhibitor/angiotensin receptor blocker therapy is a strong reminder of the potential pitfalls of such a strategy. Similar arguments could indeed be made against the comparably unproven benefits of overuse of erythropoiesis-stimulating agents and revascularization for atherosclerotic renovascular disease, modalities that are also more likely to be provided by nephrologists vs internists.1