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New guidelines for conservative management of ESRD
A clinical working group has developed a series of recommendations for nephrologists and kidney care staff to manage patients with non-dialysis dependent CKD (NDD-CKD) who choose conservative care.
Sara N. Davison, MD, with the division of nephrology and immunology, department of medicine, University of Alberta, and colleagues from various medical disciplines formed the Conservative Kidney Management Clinical Working Group in June 2015 to develop a set of guidelines to help patients at stage 5 CKD who decided not to opt for dialysis care.
“Conservative kidney management is increasingly accepted as an appropriate treatment option for patients with eGFR category 5 CKD who are unlikely to benet from dialysis and/or who choose a non-dialysis care option,” the authors wrote. “However, there remains great variation in the delivery of their care.”
With little existing evidence specic to conservative kidney management, “these recommendations are intended as a starting point toward reaching consensus and generating further evidence,” Davison and colleagues reported.
Clinicians agreed to put together a plan to develop, implement and evaluate an interactive conservative kidney management pathway across Alberta, Canada. Stakeholders and end users, including patients and family, identified the need to include recommendations for managing the complications of CKD and the symptoms specific to conservative kidney management.
“Although guidelines exist for CKD management in general and some guidance is available for symptom management for patients with advanced CKD, there are no clear guidelines or recommendations for the care of patients who choose conservative kidney management.”
The collaboration resulted in the Conservative Kidney Management Pathway, a web-based tool that includes an interactive patient decision aid to support shared decision making for dialysis treatments vs. conservative kidney management and integrated care plans designed to be individualized. The pathway includes recommendations on the management of NDD-CKD complications and common symptoms; advance care planning and goals of care; establishing community support and appropriate referrals; preparing for crises and the end of life and grief and loss.
The recommendations were written for the wide variety of health care professionals (eg, family physicians, home care nurses, pharmacists, and dieticians) who were part of the working group and who provide care for these patients. – by Mark E. Neumann
Disclosures: This work was supported by funding from Alberta Innovates Health Solutions grant 201400400.
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Davison S, et al. Clin J Am Soc Nephrol. 2019;doi:https://doi.org/10.2215/CJN.10510917.