For much of the 43 years since publicly financed dialysis care became available with the enactment of the Medicare entitlement, nephrology has been focused—with good reason—on reducing the undertreatment of kidney failure and specifically the underuse of dialysis. Conservative care for kidney failure became synonymous with the absence of dialysis treatment, which implied undertreatment. Initially, nephrology’s emphasis was on eliminating socioeconomic and geographic barriers to dialysis care. In more recent decades, the focus turned to improving the identification of kidney failure, an issue that affects primarily frail and/or older patients.