End-stage renal disease describes loss of kidney function which is both substantial and irreversible. The form of renal replacement therapy (RRT) instituted should primarily be based on patient preference subsequent to an individually tailored education programme from specialist staff. This programme needs to take into account the patient’s comorbidities and any contraindications to specific modalities of RRT. For those who will be suitable for transplantation, optimum management of diabetes, smoking cessation, weight loss, and general fitness is crucial in facilitating this.