In this module, you will learn how to identify patients who may benefit from conservative care. Please watch the following videos and answer the questions in your workbook as you go. Then complete the prognosis homework exercise. By the end of this module, you should be able to:

1.   Identify prognostic factors for survival and functional outcomes in patients with advanced kidney disease
2.   Use prognostic tools to predict survival
3.   Use communication tools to predict functional outcomes


Who benefits from conservative care

worksheet icon Put your new learning into action. Choose a patient with advanced kidney disease from your clinic who you think may benefit from conservative care. Using your worksheet, complete the answer and record your impressions

  1. Choose a patient with advanced kidney disease from your clinic who may benefit from conservative care
  2. Calculate the risk for mortality using the 6 month integrated prognostic tool
  3. Consider how they are doing in terms of function and whether they have any geriatric syndromes
  4. Choose two questions to assess for geriatric syndromes
  5. Write down these results and your impressions

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1.   Griva K, Stygall J, Hankins M, Davenport A, Harrison M, Newman SP. Cognitive impairment and 7-year mortality in dialysis patients. Am J Kidney Dis. 2010;56(4):693-703.

2.   Kurella M, Covinsky KE, Collins AJ, Chertow GM. Octogenarians and nonagenarians starting dialysis in the United States. Ann Intern Med. 2007;146(3):177-183.

3.   Kurella Tamura M, Covinsky KE, Chertow GM, Yaffe K, Landefeld CS, McCulloch CE. Functional status of elderly adults before and after initiation of dialysis. N Engl J Med. 2009;361(16):1539-1547.

4.   Kurella Tamura M, Yaffe K. Dementia and cognitive impairment in ESRD: diagnostic and therapeutic strategies. Kidney Int. 2011;79(1):14-22.

5.   McAdams-DeMarco MA, Law A, Salter ML, et al. Frailty as a novel predictor of mortality and hospitalization in individuals of all ages undergoing hemodialysis. J Am Geriatr Soc. 2013;61(6):896-901.

6.   McAdams-DeMarco MA, Suresh S, Law A, et al. Frailty and falls among adult patients undergoing chronic hemodialysis: a prospective cohort study. BMC Nephrol. 2013;14:224.

7.   Murray AM. Cognitive impairment in the aging dialysis and chronic kidney disease populations: an occult burden. Adv Chronic Kidney Dis. 2008;15(2):123-132.

8.   Anderson RT, Cleek H, Pajouhi AS, et al. Prediction of Risk of Death for Patients Starting Dialysis: A Systematic Review and Meta-Analysis. Clin J Am Soc Nephrol. 2019;14(8):1213-1227.

Estimates 6 month mortality on dialysis using the Cohen model
Assessment for Timed Up & Go