Conservative Care

What is conservative care?

Conservative care for end stage kidney disease (ESKD) patients means that your healthcare team continues your chronic kidney disease (CKD) treatment without dialysis or a kidney transplant. Conservative care does not cure your CKD, the emphasis of conservative care is on maintaining your quality of life and improving symptom management. If you wish to continue your CKD treatment journey with conservative care, your health care team will assist you to create a personalised plan to cater to your needs.

What may be the reason for choosing conservative care?

Some chronic kidney disease patients can be diagnosed with other critical conditions, such as heart failure or cancer. For such CKD patients, kidney failure forms only a part of their disease burden, and as such, the subsequent start of dialysis may not increase their survival. In addition, for CKD patients who are very old or frail, symptoms like fatigue, restless legs, poor appetite, painful joints, sleep disturbances and dementia may persist even after starting dialysis.

Therefore, patients should assess with their doctors the different CKD treatment options available. If after discussion, the possible complications associated with dialysis outweighs the benefits, CKD patients can choose to continue their CKD treatment with conservative care. After starting conservative care, the patient should be on appropriate medication, dietary planning, physiotherapy, and psychosocial support to manage their CKD symptoms.

How does one choose conservative kidney management?

CKD patients, together with their caregivers, should have early and ongoing conversations with their doctors regarding their treatment plan.  The discussion should provide the patients and caregivers with a balanced view of all the CKD treatment options available to enable patients to make an informed decision. The final decision should be a shared decision between the patients, caregivers, and doctors.

Conservative care can be considered an option during any or all of these discussions. Should you wish to pursue conservative care, you may wish to update your Advance Care Directive with your conservative decision, to ensure your wishes are adhered too.

What happens after CKD patients select conservative care?

The patient’s healthcare team will advise patients on how to slow down their chronic kidney disease progression and maintain urine output. Patients should also consult their doctor before taking any over-the-counter medication, supplements, or herbal products, as these products can potentially harm their kidneys.

The kidney care team will also advise patients on how to manage their other health conditions that can worsen their kidney function. Patients should adhere strictly to the medication regimen prescribed by their doctors to keep their symptoms under control. Regular monitoring of their blood pressure and blood glucose level is also essential in delaying disease progression.

The patient will also be advised to follow an appropriate diet plan to moderate the sodium, potassium, and phosphorus level in their body. Patients are also expected to follow a daily fluid restriction as fluid management is important to avoid both dehydration and fluid overload.

Who can provide conservative care to chronic kidney disease (CKD) patients?

Conservative care is managed by a dedicated team of healthcare professionals made up of doctors, nurses, pharmacists, dietitians, psychologists, and physiotherapists to provide the patient with holistic, personalised care. The team will advise on the best care plan to achieve the goals of conservative care, i.e., managing symptoms and preserving remaining kidney function while maintaining the patient’s quality of life. Conservative care can take place in the hospital, at a hospice or at home. Some hospitals may even offer regular home visits by nurses to closely monitor patients’ conditions and disease progressions.

Can patients on conservative care switch to other CKD treatment options? 

CKD patients who are on conservative care should be given the flexibility to switch to any other treatment option at any point in their therapy.