Newly diagnosed cases of end stage renal disease (ESRD) have increased by 9% each year since 1970. It has been estimated that there will need to be a significant increase in the number of nephrologists to care for the ESRD population by the year 2010. Recent reports have advocated the use of advanced practice nurses (APN) to collaborate with nephrologists to meet increasing patient care demands. Clinical evidence has supported the financial and clinical advantages of APN utilization in nephrology. The renal community has stressed an outcome-based practice with a provision of guidelines to improve morbidity and mortality in ESRD. Reimbursement and mortality have been linked to identification of quality care delivery. APNs can be instrumental in assuring that quality patient care is delivered across the ESRD continuum through several different roles: clinician, educator, consultant, researcher, administrator, and case manager.