Conservative Management for Kidney Failure

What is conservative management?

Conservative management for kidney failure means that your health care team continues your care without dialysis or a kidney transplant. The focus of care is on your quality of life and symptom control.

You have the right to decide how your kidney failure will be treated. You can choose conservative management instead of dialysis or transplant.

Health care provider shares information with a woman in her home.
Your health care team can tell you more about your health status and conservative management.

What are other names for conservative management?

You may hear conservative management called comprehensive conservative care, supportive care, nondialytic care, and comfort care. You also might hear the term “palliative care,” which is one part of conservative management. Palliative care addresses the physical, psychological, and spiritual needs of someone with a serious illness.

What happens if I choose conservative management?

Your health care team will help you create a plan to meet your care needs. Your health care team may include a nephrologist, primary care clinician, nurse, dietitian, social worker, and a pharmacist.

Treatment includes

  • preserving kidney function for as long as possible
  • managing your symptoms, such as nausea, poor appetite, and your feelings
  • managing other health problems caused by kidney failure, such as anemia
  • maintaining your quality of life for as long as possible
  • preparing for end-of-life care

Conservative management won’t cure kidney disease. The treatment goals are to

  • provide the best quality of life.
  • avoid treatments and hospital stays that may worsen quality of life. This may mean fewer medical appointments, blood draws, and medicines.

Your care plan may change as your quality of life and health status change. As you near the end of your life, you may choose hospice care.

One man comforting another in an outdoor setting.
You may want to talk with friends and family members about your decision.

What is hospice?

Hospice is a program of care and support for people at the end of life. A trained team of health professionals and caregivers provide symptom and pain relief as well as emotional and spiritual support. The hospice team also supports family caregivers.

With hospice care, you may choose to die at home or in a home-like hospice setting instead of in a hospital.

Medicare, the federal health insurance program, covers hospice care.

Who chooses conservative management?

People who wish to focus their care on the quality of their life may choose conservative management.

For most people, dialysis may extend and improve quality of life. For others, this is not true. Dialysis may not lengthen life for all people who have kidney failure and can feel like an added burden, especially for people who have other serious health problems. Dialysis may not prolong or improve the quality of life for people who

Your health care provider can help you and your family understand your health status so you can make an informed decision.

What should I eat while on conservative management?

What you eat and drink may make you feel better and may help prolong your life.1 Work with a dietitian to help you choose what to eat.

Family eating together.
You can eat with your family and choose foods from the same table to fit your nutrition needs.

How will I feel?

As the waste products build up in your blood, your appetite may decline and you may become less alert. Your health care team can help you address these and other symptoms.

How long can I live if I choose conservative management?

The answer to this question is different for each person. If you need dialysis to survive and don’t receive it, you may live a few days or weeks.2

Man comforting a person who is reclining under some blankets.
If you stop dialysis, you’ll be switched to comfort care or hospice.

References

January 2018
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This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings through its clearinghouses and education programs to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.

The NIDDK would like to thank:
Jane Schell, MD, Assistant Professor of Medicine, University of Pittsburgh, Section of Palliative Care and Medical Ethics, Division of Renal-Electrolyte