Core duties is establishing a plan of care for kidney patients. It's centered around slowing the progress of kidney disease, and incorporates diet and lifestyle changes, as well as close control over medications. Many common drugs used to treat other diseases can aggravate kidney disease, including over-the-counter painkillers. The nephrologist must review all of a patient's medications to minimize unnecessary risks, and identify potentially harmful interactions between otherwise-beneficial drugs. Nephrologists must also coordinate care with physicians treating other conditions, such as high blood pressure, diabetes or anaemia that contribute to or result from kidney disease.
Chronic kidney disease results in diminished kidney function over time, with the rate of deterioration varying from case to case. When the kidneys become seriously impaired, the nephrologist will usually order a course of dialysis, which mechanically cleanses the blood in much the same way healthy kidneys do. Ultimately, many patients require a kidney transplant to survive. The transplant surgery is performed by a urologist, but the nephrologist is responsible for managing the patient's care before and after the surgery, to maximize the likelihood of a successful outcome.