Of the 20 million people in the united states living with chronic kidney disease,about 8 million are in the middle or late stage of the illness;700000 are near or in kidney failure. Nursing care of these patients can be quite challenging. There's little time to prepare them after diagnosis of imminent kidney replacement therapy,and many begin dialysis weak, tired, and malnourished.patients and families are often afraid:hospitalizations are frequent;complications such as anemia, bone disease, cardiovascular disease,dyslipidemia, and depression are common;death seems near.