Conservative kidney care

Doctor standing up chatting with kidney patient

What is conservative kidney management?

Conservative kidney care involves active management of physical symptoms of kidney failure and accompanying diseases and symptoms, as well as psychological and social support without using dialysis or transplantation, although technically dialysis could be considered as indicated.

Who chooses conservative kidney management?

Especially when a patient is suffering from one or more other serious diseases, for example diabetes, heart failure or cancer, kidney failure is only one part of the disease burden and subsequent start of dialysis may neither cure nor diminish the intensity of symptoms and may not be associated with increased survival.

Doctor standing up chatting with kidney patient

How does one choose conservative kidney management?

The decision about future treatment choice should ideally be a shared decision between the patient, relatives, and the healthcare professionals. The kidney doctor can estimate the individual’s outcome with the use of specific prognostic tools and algorithms and should share a clear view of future disease trajectory, time frames, and discuss advantages and disadvantages of both dialysis and conservative treatment. Every patients’ own goals and preferences need to be considered and all patients should be appropriately counseled before dialysis initiation about all treatment options and likely outcomes.

Illustration of pills and medicine

Which aspects are covered and symptoms addressed during conservative kidney management?

The kidney care team gives the advice on how to slow down the progression of kidney disease and maintain urine output while preserving quality of life. The important issues concern: pain management, blood pressure control, appropriate diet and fluid management to avoid both dehydration and fluid overload, blood glucose monitoring (for diabetics), intake of prescribed medicines, anemia management, and symptom control. It is important to check any new medicines, intake of painkillers, supplements and herbal products as some of them may further damage the kidneys.

Can one change their mind about treatment choice?

Each patient should be offered information on and the possibility to modify their choice (i.e. moving from conservative treatment to dialysis or vice versa). In addition, some patients choose a so-called time-limited trial of dialysis, whereby in advance a time limit is set for abandoning dialysis if not enough improvement occurs (e.g. 6 - 8 weeks).

Doctors and nurses standing up

Who is providing conservative kidney management?

Depending on the country-specific healthcare system, conservative care is managed by the kidney care team (kidney doctors and nurses) with involvement of primary care workers (family doctors and nurses, social workers) as well as dietitians, psychologists and physiotherapists, if available.