Conservative kidney management and kidney supportive care: core components of integrated care for people with kidney failure

Abstract

Integrated kidney care requires synergistic linkage between preventative care for people at risk for chronic kidney disease and health services providing care for people with kidney disease, ensuring holistic and coordinated care as people transition between acute and chronic kidney disease and the 3 modalities of kidney failure management: conservative kidney management, transplantation, and dialysis. People with kidney failure have many supportive care needs throughout their illness, regardless of treatment modality. Kidney supportive care is therefore a vital part of this integrated framework, but is nonexistent, poorly developed, and/or poorly integrated with kidney care in many settings, especially in low- and middle-income countries. To address this, the International Society of Nephrology has (i) coordinated the development of consensus definitions of conservative kidney management and kidney supportive care to promote international understanding and awareness of these active treatments; and (ii) identified key considerations for the development and expansion of conservative kidney management and kidney supportive care programs, especially in low resource settings, where access to kidney replacement therapy is restricted or not available. This article presents the definitions for conservative kidney management and kidney supportive care; describes their core components with some illustrative examples to highlight key points; and describes some of the additional considerations for delivering conservative kidney management and kidney supportive care in low resource settings.

Keywords: conservative kidney management; health care policy; integrated kidney care; kidney failure; kidney supportive care.

Figure 1 |. Treatments and the role of kidney supportive care (KSC) for people with kidney failure (KF).

The increasing size of the green hexagon (representing KSC) from transplant to dialysis to conservative kidney management (CKM) conceptualizes the increasing role that KSC plays with each active KF treatment. Where kidney replacement therapy (KRT) is available, people should select a KF treatment option through shared decision-making. Where KRT is not available, choices are restricted, and people typically do not receive the care they would have chosen through shared decision-making if the appropriate resources had been available. HD, hemodialysis; PD, peritoneal dialysis.

Figure 2 |. Conservative kidney management (CKM) within a framework for establishing integrated kidney care programs in low- or middle-income countries.

Adapted from Tonelli et al. HD, hemodialysis; KRT, kidney replacement therapy; PD, peritoneal dialysis; SDG, sustainable development goal.

Figure 3 |. Considerations before receiving conservative kidney management (CKM) through a choice-restricted pathway.

CKD, chronic kidney disease; KRT, kidney replacement therapy; KSC, kidney supportive care; NGO, nongovernmental organization.

Figure 4 |. Potential hub-and-spoke model to support competency-based capacity from conservative kidney management (CKM) at institution, community, and national levels.

HC, health care; MDT, multidisciplinary team.