For those patients with CKD followed in a pre-dialysis environment, it is well appreciated that modality education leads to an informed decision regarding type of dialysis selected. However, for those individuals starting dialysis acutely and requiring chronic renal replacement therapy, modality education may be lacking. Because of the acuity of the dialysis start, and the intercurrent illness or event which precipitated and acute start, these patients require a specialized approach to education, and indeed, require a combination of education and support to learn about and choose a renal replacement therapy. The University Health Network, in Toronto, Canada, has developed a program and approach to education and support of this group of patients. The approach, results, and theoretical underpinnings of this program are reviewed, and a potential new “hybrid” educational framework is proposed.