In this module you will learn how to define conservative care and describe its relative outcomes. Please watch the following videos and answer the questions in your workbook as you go. By the end of this module, you should be able to:

1.   Define what conservative care is and how it is delivered
2.   Describe survival and experience for patients on conservative care
3.   Outline a three-step approach to decide whether conservative care is right for your patient


Defining conservative care



Survival



Patient Experience


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Modules
1 Why conservative care?
2 Identify who benefits
3 Learn what matters most
4 Make a recommendation

References:

1.   Carson RC, Juszczak M, Davenport A, Burns A. Is maximum conservative management an equivalent treatment option to dialysis for elderly patients with significant comorbid disease? Clin J Am Soc Nephrol. 2009;4(10):1611-1619.

2.   Chandna SM, Da Silva-Gane M, Marshall C, Warwicker P, Greenwood RN, Farrington K. Survival of elderly patients with stage 5 CKD: comparison of conservative management and renal replacement therapy. Nephrol Dial Transplant. 2011;26(5):1608-1614.

3.   Da Silva-Gane M, Wellsted D, Greenshields H, Norton S, Chandna SM, Farrington K. Quality of life and survival in patients with advanced kidney failure managed conservatively or by dialysis. Clin J Am Soc Nephrol. 2012;7(12):2002-2009.

4.   Morton RL, Webster AC, McGeechan K, et al. Conservative Management and End-of-Life Care in an Australian Cohort with ESRD. Clin J Am Soc Nephrol. 2016;11(12):2195-2203.

5.   Murtagh FE, Burns A, Moranne O, Morton RL, Naicker S. Supportive Care: Comprehensive Conservative Care in End-Stage Kidney Disease. Clin J Am Soc Nephrol. 2016;11(10):1909-1914.

6.   O'Connor NR, Kumar P. Conservative management of end-stage renal disease without dialysis: a systematic review. J Palliat Med. 2012;15(2):228-235.

7.   Verberne WR, Geers AB, Jellema WT, Vincent HH, van Delden JJ, Bos WJ. Comparative Survival among Older Adults with Advanced Kidney Disease Managed Conservatively Versus with Dialysis. Clin J Am Soc Nephrol. 2016;11(4):633-640.

8.   Davison SN, Tupala B, Wasylynuk BA, Siu V, Sinnarajah A, Triscott J. Recommendations for the Care of Patients Receiving Conservative Kidney Management: Focus on Management of CKD and Symptoms. Clin J Am Soc Nephrol. 2019;14(4):626-634.

9.   Wong SPY, McFarland LV, Liu CF, Laundry RJ, Hebert PL, O'Hare AM. Care Practices for Patients With Advanced Kidney Disease Who Forgo Maintenance Dialysis. JAMA Intern Med. 2019;179(3):305-313.

Tools/resources:

https://kidneysupportivecare.org/
Coalition for the Supportive Care of Kidney Patients, includes helpful resources for clinicians, patients and families

http://ckmcare.com/
The Conservative Kidney Management (CKM) pathway is a resource for patients and care providers to help in the management of kidney disease with a focus on quality of life, symptom management, and living well without dialysis. Includes resources for clinicians and patients including a patient decision aid