The latest National Health and Nutrition Study revealed an increasing incidence of kidney disease among aging baby boomers, as the incidence of diabetes mellitus and hypertension rises. Because of this trend, a greater proportion of a primary care physician's practice will involve patients with chronic kidney disease, and consequently, end stage renal disease. Unfortunately, far too many of these chronic kidney disease patients are referred to a nephrologist very late. More often than not, the opportunity for secondary preventive intervention, with the goal of avoiding renal replacement therapy, is lost. This article addresses the various treatment options for patients with end stage renal disease.