Improving Medical Decision Making for Older Patients With End Stage Renal Disease

Inclusion Criteria: * Patients age ≥70 are eligible if they have EITHER Advanced CKD defined as ONE eGFR value ≤ 30 ml/min/1.73m2 in the past 12 months NOT determined to be a result of AKI OR Have a diagnosis of CKD and less than a two-year prognosis from any cause, defined by the clinician answering "NO" to the Surprise Question ("Would you be surprised if this patients died in the next two years?") * Patients age 65-69 are eligible if they have BOTH Advanced CKD defined as ONE eGFR value ≤ 30 ml/min/1.73m2 NOT determined to be a result of AKI AND Have less than a two-year prognosis, defined by the clinician answering "NO" to the Surprise Question ("Would you be surprised if this patients died in the next two years?") * Patients who have not had a nephrology visit in the past 12 months can be recruited from non-Nephrology Clinics per the above eligibility criteria Exclusion Criteria: * listed for kidney transplantation or previous transplant recipient * already on or previously on dialysis (including emergent dialysis) * new patient visit * visually impaired beyond 20/200 corrected * psychological state not appropriate for ACP discussions as determined by the primary nephrologist * cognitive impairment