Screening and preventive health practices for the end-stage renal disease patient

The population of end-stage renal disease (ESRD) patients continues to grow and to age. The nephrologist often is the sole or principal physician resp onsible for the total management of these patients. In this role, the nephr ologist must address issues of routine health maintenance. Screening tests and preventive care should be continued to detect, prevent, or minimize com orbid conditions that could affect quality of life or survival. Effective p rimary and secondary prevention requires understanding the principles of sc reening tests and their appropriate use. Screening and counseling procedure s recommended for healthy adults should be continued, although certain scre ening tests may appropriately be discontinued if the expected survival is 5 years or less. Secondary prevention for cardiovascular disease is particularly important i n ESRD patients, in whom accelerated atherosclerosis is often the cause of morbidity and death. Aggressive counseling in smoking cessation and in mana gement of hyperlipidemia should be undertaken, in the hopes of limiting thi s common comorbidity. (C) 2000 by the National Kidney Foundation, Inc.