Patient inclusion criteria:  age ≥18 years, residing in the United States, a referral diagnosis of CKD G5D, will receive care at the facility for at least six months, stable as defined by CMS - Conditions for Coverage for ESRD Facilities Regulation V52029 applied per the RDNs' clinical judgement or facility policy  Patient: Exclusion criteria include:  patients without a CKD G5D diagnosis prisoners pregnant women,