The transition from chronic kidney disease (CKD) to kidney failure requiring replacement therapy represents a high risk-period for patients as they become dependent on medical technology to sustain life. Many patients report the transition to dialysis as frightening, citing emotional difficulties at the time of transition and during the early months of treatment that are not systematically addressed and managed.1 The reasons for the psychological distress associated with the transition from CKD without kidney replacement therapy to dialysis are likely multifactorial and include a lack of awareness of kidney disease, lack of preparation for next steps, feelings of loss of control, and financial or housing-related transitions that may occur simultaneously to the patient and/or their caregiver.