Submission No. : RCC1-0002
Session Title : Renal Conservative Care (Geriatrics 1)
Session Topic : Conservative Care in Kidney Patients
Date & Time, Place : June 13 (Thu) / 15:30-17:00 / Room 5 (202)
Conservative Kidney Management - When, Why, and for Whom
Chenlei Kelly Li
St George Hospital, Sydney, Australia
Conservative Kidney Management (CKM) is care for people with kidney failure that focuses on promoting quality of life, and does not include kidney replacement therapy. It is an active treatment pathway that aligns with the individual’s preferences, goals, and prognosis, and includes
- Interventions to slow the progression of kidney disease and manage its complications, as far as they align with the individual’s preferences and goals;
- Involvement of a multidisciplinary team to manage physical, psychosocial, and spiritual needs, optimise function, and actively support families and caregivers;
- Care that is provided from advanced stages of CKD to the end of life.
For a long time, dialysis has been framed by many as the default treatment for kidney failure. In more recent years, CKM is increasingly recognised as a viable, evidence-based alternative to dialysis, particularly for elderly or otherwise transplant ineligible CKD patients who may not derive significant benefit from dialysis in terms of longevity and/or quality of life. For some patients, CKM may better align with goals and preferences, improve symptoms, with modest to no loss in longevity.
As individuals with kidney failure are increasingly older and co-morbid, it becomes more pertinent to provide balanced information about treatment options. Nephrologists should be familiar with the benefits and burdens of both dialysis and CKM, in terms of prognosis, symptom burden, functional trajectory, and impacts on quality of life. As these decisions are complex, and yet have profound impacts on people’s lives, both medical and non-medical factors must be carefully considered, as well as social and cultural context. At an institutional level, treatment options should be discussed early in the disease trajectory, and a referral pathway should be embedded within the nephrology unit so that all patients have access to CKM as a treatment option.
Keywords: conservative kidney management, kidney supportive care