The importance of prognosis in cancer screening in patients with chronic kidney disease.

The high mortality of end-stage renal disease (ESRD) suggests that general cancer screening in this population is costly and of little value. Patients with ESRD awaiting transplantation and those who have been successfully transplanted require cancer screening because of their higher expected survival and increased cancer risk. If shared decision-making is to guide cancer screening protocols that are individualized based on cancer risk, transplantation status, and expected survival, it is incumbent upon nephrologists to discuss overall expected survival with their patients with ESRD. Most nephrologists are poorly trained in the communication skills needed to address these issues and feel uncomfortable engaging in such discussions. The revised clinical practice guideline, "Shared Decision-Making in the Appropriate Initiation of and Withdrawal from Dialysis," is a useful resource which nephrologists may consult when facing such situations.