Recommendations for the Care of Patients Receiving Conservative Kidney Management: Focus on Management of CKD and Symptoms

Abstract

Conservative kidney management is increasingly accepted as an appropriate treatment option for patients with eGFR category 5 CKD who are unlikely to benefit from dialysis and/or who choose a nondialysis care option. However, there remains great variation in the delivery of their care. As part of the development of a conservative kidney management pathway that is undergoing evaluation, a set of recommendations specific to conservative kidney management for managing the complications of CKD and common symptoms was developed. These recommendations focus on the patient's values and preferences and aim to optimize comfort and quality of life. Explanations for the interventions are provided to support the shared decision-making process between health care professionals, patients, and family members. The recommendations generally emphasize the preservation of function (cognitive, physical, and kidney) and address symptom burden, acknowledging that management priorities can change over time. The recommendations should be used in conjunction with other key elements of conservative kidney management, including clear communication and shared decision making for choosing conservative kidney management, advance care planning, and psychosocial support. Although there are limitations to the existing evidence specific to conservative kidney management, these recommendations are intended as a starting point toward reaching consensus and generating further evidence.

Keywords: Advance Care Planning; Chronic; Cognition; Consensus; Conservative Kidney Management; Conservative Treatment; Decision Making; Humans; Palliative Care; Recommendations; Renal Insufficiency; Symptoms; chronic kidney disease; end stage kidney disease; glomerular filtration rate; quality of life; renal dialysis.

Copyright © 2019 by the American Society of Nephrology.

Figures

Figure 1.

Key components of the Conservative Kidney Management Pathway. Reprinted from the Kidney Supportive Care Research Group (3), with permission.

Figure 2.

Clinical condition is incorporated into the conservative kidney management recommendations.