Timely nephrology referral potentially could have many benefits in allowing earlier identification and treatment of reversible causes of chronic kidney disease. Winkelmayer and colleagues analyze data from January 1, 1996, through December 31, 2006, and report that although early nephology consultation is increasing, no associated decrease in mortality has been observed. However, as part of a national trend toward earlier diagnosis (and treatment) of disease in the past decade, Americans have been starting dialysis with increasingly preserved kidney function and are being prescribed higher dosages of erythropoietin. Because this article identifies an area of increased nephrology care and increasingly early dialysis with no material mortality benefit, it has been given our “Less Is More” designation.
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