Conservative care of end-stage renal disease
- Jane O Schell, MD
Jane O Schell, MD
- Assistant Professor of Medicine
- University of Pittsburgh School of Medicine
- Robert M Arnold, MD
Robert M Arnold, MD
- Editor-in-Chief — Palliative Care
- Section Editor — General Principles of Palliative Care
- Chief, Section of Palliative Care and Medical Ethics
- University of Pittsburgh School of Medicine
This topic review describes conservative (nondialytic) care as a treatment option for patients with end-stage renal disease (ESRD) who elect not to pursue dialysis or transplant.
Palliative care for ESRD patients and issues related to the withdrawal of dialysis are discussed elsewhere. (See "Palliative care: End-stage renal disease" and "Withdrawal from and withholding of dialysis".)
Conservative ESRD care is the care of patients with ESRD without renal replacement therapy such as dialysis or transplantation. Active supportive care, maximal conservative management, and nondialytic management are also terms commonly used to describe such treatment. Kidney Disease: Improving Global Outcomes (KDIGO) defines comprehensive conservative care as planned, holistic, patient-centered care for patients with stage 5 chronic kidney disease (CKD; ie, estimated glomerular filtration rate [eGFR] <15 mL/min/1.73 m2) . (See "Definition and staging of chronic kidney disease in adults", section on 'Staging of CKD'.)
Conservative ESRD care is appropriate for patients who choose not to initiate dialysis or undergo kidney transplantation. Such patients generally include those with coexisting, advanced comorbidities who may not gain meaningful benefit from renal replacement therapy or whose care preferences are to avoid intensive medical therapies and receive care that focuses on quality of life. The goals of conservative care are to optimize quality of life, treat the symptoms of ESRD without dialysis or transplant, and, when appropriate, preserve residual renal function.
Conservative care is best delivered through a collaborative, interdisciplinary team consisting of a nephrologist, primary care clinician, nurse, dietician, social worker, and, when appropriate, palliative care team.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- WHO SHOULD BE OFFERED CONSERVATIVE CARE
- COMPONENTS OF CONSERVATIVE CARE
- Medical management
- - Minimization of renal progression
- - Blood pressure management
- - Anemia and iron deficiency
- - Mineral and bone disease
- - Acidosis
- - Hyperkalemia
- Symptom management focused on optimizing quality of life
- - Symptom evaluation
- - Management of symptoms
- Anorexia, nausea, vomiting
- Psychological symptoms
- Advance care planning
- Palliative care expertise
- End-of-life care
- - End-of-life symptoms
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS