Conservative Management of Chronic Kidney Disease

Reviewed by: HU Medical Review Board | Last reviewed: February 2023

Choosing conservative management is an important decision that someone with advanced chronic kidney disease (CKD) or kidney failure may have to make. If you have CKD or you are a caregiver of someone with CKD, knowing what is involved in this type of medical care can have a big impact on your future.1,2

What is conservative management?

For people with kidney failure (also called end-stage kidney disease), conservative management means deciding not to do dialysis or have a kidney transplant. Conservative management does not treat your kidney disease. Instead, it focuses on controlling symptoms, maximizing comfort, and improving your quality of life.2,3

Conservative management is also known by other names, such as:2,3

  • Comprehensive conservative care
  • Medical management
  • Palliative care
  • Non-dialytic care
  • Comfort care
  • Supportive care

Who is it for?

Conservative management is for people who choose not to treat their kidney failure with dialysis or a kidney transplant. Many people can prolong their life with dialysis. But this is not the case for everyone.2

People with CKD who are elderly, frail, or have other serious health complications may not benefit from dialysis. It may potentially do more harm than good.2,4,5

These people may choose to not undergo dialysis at all or stop it after giving it a try. At this point, conservative management aims to keep them comfortable. Steps are taken to improve their quality of life as much as possible.2-4

How does conservative management work?

With conservative management for CKD, your care team may include:1

  • Kidney specialist doctor (nephrologist)
  • Primary care doctor
  • Nurse
  • Dietitian
  • Social worker
  • Pharmacist
  • Palliative care specialist

Conservative management care helps to preserve kidney function for as long as possible without painful or invasive treatments. It also helps to manage:2,3

  • Pain
  • Symptoms such as nausea or loss of appetite
  • Emotions
  • Nutrition
  • Other health problems, such as anemia and fluid buildup

How is it different from hospice care?

Hospice care is specialized medical care that is meant for someone who is at the end of their life, usually with only a few months left to live. Hospice care can be given at home or in a hospice center.2,3,4,6

Similar to conservative management, hospice care provides relief from symptoms and helps keep you comfortable. It also provides emotional support to you and your family.2,3

As time goes on, you may need to transition from conservative management to hospice care. If you have questions, talk with your doctor about hospice care.2,4

Making an advance directive

No matter what treatment you choose for your kidney disease, you will want to create an advance directive. This is especially true if you choose conservative management. An advance directive is a care plan that details exactly which treatments you do and do not want at the end of your life.3

Keep this plan in writing. Make sure it is in a safe place at home, and share it with your family. While it can be hard to think about end-of-life care, it will help clarify and explain your wishes to your family when that time comes.3

How do I know if conservative management is right for me?

Choosing conservative management over dialysis or a kidney transplant is a decision that only you can make. Every person’s situation is unique. Talk with your doctor, healthcare team, caregiver, and family about what is right for you.2,3

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