Conservative Management of Advanced Kidney Disease

Conservative management of advanced kidney disease refers to the non‐dialytic care pathway designed to preserve renal function, maintain quality of life and address symptom burden in patients for whom dialysis may offer limited benefit. This approach integrates dietary modification (often a low‐protein regimen), meticulous fluid and electrolyte control, active symptom relief (for anaemia, pruritus, nausea and pain), psychosocial support and advance care planning. It is underpinned by a multidisciplinary team comprising nephrologists, nurses, dietitians, social workers and palliative care specialists. Key objectives are to align treatment with individual values, avoid unnecessary hospitalisation and maintain functional independence, particularly in older or frail patients with high comorbidity. Globally, conservative management has gained prominence as populations age and the balance between treatment burden and survival benefit becomes central to decision making. Its practical application involves shared decision‐making frameworks, regular assessment of renal trajectory (often via estimated glomerular filtration rate), periodic review of symptom scores and early discussions about end‐of‐life preferences. This pathway emphasises patient autonomy, tailored interventions and judicious use of resources, offering a robust alternative to dialysis in selected cases.

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Conservative Management of Advanced Kidney Disease publication trend

The graph below shows the total number of articles in conservative management of advanced kidney disease across all publications each year (not limited to Nature Index journals).

Technical terms

Estimated glomerular filtration rate (eGFR): A calculated measure of kidney function used to track progression of chronic kidney disease.

Comorbidity index: A scoring system to quantify the burden of additional diseases in a patient, often predicting survival and treatment tolerance.

Comprehensive conservative management (CCM): A holistic care model for advanced kidney disease that excludes dialysis but includes diet, symptom control and psychosocial support.

Quality of life (QoL): A multidimensional concept encompassing physical, mental and social well‐being as perceived by the patient.

Advance care planning (ACP): A process of discussing and documenting patient preferences for future medical care, particularly at end of life.

References

1. Shared decision making in elderly patients with kidney failure. Nephrology Dialysis Transplantation (2023).
2. The Quality of Life in Elderly Patients in Comprehensive Conservative Management or Hemodialysis: A Case–Control Study in Analogous Basal Conditions. Nutrients (2024).
3. Value-based evaluation of dialysis versus conservative care in older patients with advanced chronic kidney disease: a cohort study. BMC Nephrology (2018).