Conservative kidney management

Patient considerations for all treatment options:

• Goals (what matters to the patient, e.g. caring for others, family events, children, grandchildren, farming, travel, school attendance)
• Values (balancing quality of life, length of life, dignity, body function, difficult treatments, relief of pain and suffering, fear of dying)
• Social support (independence, caring for someone or receiving care)
• Work, school, university
• Activities (sport, clubs, hobbies)
• Life stage (age, accomplishments, bucket list)
• Transport (treatments, medical appointments)

Specific patient considerations for conservative kidney management:

• Importance of independence and self-management
• Isolation from other conservative kidney management patients
• Importance of spending time with family and friends
• Unwilling to undergo dialysis treatment 3 times a week
• Unable to travel for dialysis
• Unable to do home dialysis
• Not prepared to move closer to other treatments

Clinical considerations for all treatment options:

• Comorbidities (other health issues such as diabetes, cardiovascular disease, obesity, cancer, frailty)
• Lifestyle (diet, exercise, smoking and vaping, drinking, recreational drug use)
• Goals of care (including advance care plan, advance care directive, resuscitation plan)
• Maintaining healthy sex life
• Considering pregnancy

Specific clinical considerations for conservative kidney management:

• Suitability for dialysis
• Suitability for transplant
• Availability of complete renal healthcare team, including a nephrologist (kidney doctor), renal nurse, social worker and dietitian at a minimum. If required, other allied health such as physiotherapist, occupational therapist, podiatrist, exercise physiologist, clinical psychologist, pharmacist, or audiologist to manage treatment (may be through virtual care)
• Prognosis (likely outcome of the disease) – this can change suddenly or it could remain stable for years

Aboriginal people may have additional considerations to be discussed for this treatment:

• Wish to stay on Country
• Support from mob to remain as healthy as possible
• Housing not set up for home dialysis
• Wish to avoid regular hospital visits

Resource

Yarning to Make Health Decisions Together
This tool helps Aboriginal people and clinicians make health and wellbeing decisions together based on values and beliefs.
Source: Agency for Clinical Innovation

Decisions relating to the management of children with renal failure are difficult. Each child or young person and their family (or carers) is different. Considerations include severity of the disease or difficulties undertaking dialysis, as well as other factors including quality of life and eligibility for transplant.

Conservative kidney management is an uncommon treatment choice for children and young people but may be appropriate after individual circumstances have been considered.

For babies, peritoneal dialysis could be undertaken for the long-term for those with renal failure and no other health issues. For babies with other congenital abnormalities, dialysis may not improve outcomes.³

Benefits of conservative kidney management require discussion and understanding:

• No requirement to travel to dialysis centre 3 times per week for treatment
• No procedures (fistulas, access devices, transplant)
• No disruption to the home environment
• Not tied down due to treatments, so can still travel and participate in activities
• Able to spend more time with family and friends

There may be medical, practical or personal reasons why conservative kidney management is not the right choice of treatment for a patient, e.g. life expectancy may be shorter for younger people or those without other significant health issues.