There's no doubt about it, end-stage renal disease (ESRD) is a costly, complex disease to manage. It may be less prevalent than other chronic diseases, but its high treatment costs ($US50 000-$US100 000/patient/year) mean that ESRD can cost a 1 million-member health plan > $US50 million annually. At this price, it's no wonder that several managed-care organisations in the US have made ESRD a target for disease management (DM). Indeed, the experiences of these companies - presented at the 2nd Annual Disease Management Leadership Forum*[Baltimore, Maryland, US; November 2000] - indicate that investment in ESRD DM is a canny move, one that not only improves clinical outcomes and member satisfaction, but also produces the hoped-for return on investment.