Kidney failure care options: Conservative kidney management
There are ways to manage advanced kidney disease and live with comfort and dignity. Learn about conservative management and its key components, active medical management and palliative care, so you can make a decision that fits your goals and maintains your quality of life.
Living with advanced chronic kidney disease (CKD) requires making important decisions about your care and comfort. Understanding what each type of care can offer may help you feel more prepared and supported as you decide what's right for you and your loved ones. When your kidneys fail, there are several paths you can take. There's no "right" choice, only what's right for you. No matter what path you choose, the goal is to help you live as long and as comfortably as possible.
What is conservative management?
Conservative management is an approach to caring for people with advanced CKD who choose not to start dialysis. Dialysis is a major commitment that can bring new challenges. For some, especially those who are older, frail or living with other serious health conditions, dialysis may not extend life and can mean spending less time at home.
Conservative management focuses on comfort and living as long as possible without dialysis. There are two main components to conservative management: active medical management and kidney supportive care (sometimes referred to as palliative care).
What is active medical management?
Active medical management is the part of the care plan that focuses on slowing kidney disease progression, controlling related conditions (such as diabetes), treating complications from kidney disease (such as anemia or bone disease), through medicines, and diet and lifestyle changes to help maintain quality of life and kidney function. For some patients, medical management may help to slow CKD progression depending on the cause of the disease, to help your kidneys function for as long as possible. In many ways, this is part of the continuum of kidney care you might already have been receiving during the earlier stages of kidney disease. For patients who choose dialysis, active medical management is also an important part of their care.
Medical management of kidney disease may include:
- Controlling high blood pressure and diabetes: This may include using medicines like ACE inhibitors to lower blood pressure and reduce protein in the urine or SGLT2 inhibitors to lower blood sugar and slow kidney damage
- Treating anemia (low red blood cells): This may include using iron supplements and erythropoietin stimulants to encourage red blood cell production
- Supplements like vitamin D for bone health
- Diuretics to remove excess fluid and manage swelling
- Bicarbonate supplements to combat build-up of excess acids
- Medicine to help the body remove mineral build up
- Following a kidney-friendly eating plan: Making changes to what you eat can help reduce the stress on your kidneys and manage symptoms. This may include limiting foods high in sodium, phosphorus, and potassium, restricting the amount of fluids you drink and generally following a kidney-friendly eating plan that supports your overall health.
What is kidney supportive care?
Kidney supportive care focuses on the whole person, not just the kidney disease. It provides symptom relief, emotional and spiritual support, support for caregivers and loved ones, and advance care planning. While medical management focuses on treating the medical aspects of kidney disease, supportive care takes a more holistic approach, addressing not just your medical needs, but also your overall well-being and quality of life.
Other healthcare professionals, such as social workers, spiritual advisors and therapists, are often involved in helping with kidney supportive care. Palliative care specialists are also sometimes involved when patients have special needs. Patients who pursue dialysis also benefit from kidney supportive care and can also be a part of their care.
Kidney supportive care can help you manage:
- Pain and symptoms like nausea (feeling sick to your stomach), swelling, itching, fatigue or trouble sleeping
- Emotional challenges, including anxiety, depression, grief or stress
- Spiritual or existential distress
- End-of-life care and planning
- Coordination between all your doctors and specialists
- Support for your loved ones and caregivers
How long will I live if I choose conservative management?
No one can say exactly how long you will live if you choose conservative management. Everyone's health is different. It depends on many things, such as your age and what other medical problems you have. What matters most is that your care team will focus on keeping you healthy and comfortable for as long as possible.
How do I prepare for conservative management?
Talk with your doctor about conservative management, so you know what to expect. Together, you can decide on what's most important to you and what you want to get out of your care. Your care plan will depend on your individual needs, circumstances, goals and kidney disease history.
You can also create an advance directive, a written plan that explains what your health priorities are and which treatments you would or would not want if you were to become sick or were near the end of life. Keep a copy in an easy-to-find place at home and share it with your family so your wishes are clear.
Making decisions that feel right for you
Your ideal care plan should reflect three important things: your personal values, your unique health needs and the activities that bring your life meaning and joy.
To help uncover what matters most to you, consider these guiding questions:
- What does a "good day" look like for me now?
- How do I feel about medical procedures and hospital visits?
- What activities are most important for me to maintain?
- How does my family feel about different treatment options?
- What are my biggest concerns about the future?
Advocate for yourself
Talk to your care team about your goals to determine what kind of support is available to help you feel your best.
Ask about:
- All your treatment options
- What to expect with each option
- How to get support for pain, stress and daily life
You can also ask to speak with a palliative care specialist, social worker or mental health professional to help you plan your care.
Prepare for end-of-life care
When kidney disease becomes very advanced and treatments can no longer help, patients enter the end of their lives. Planning for the end of life involves more than medical decisions. It also means talking openly with your loved ones and making space for caregivers to look after their own well-being. Honest conversations and strong support can ease stress, protect your comfort, and give everyone peace of mind.
What is hospice care?
Hospice care is an option for any patient, including those who receive conservative management. To be eligible for hospice care, a patient generally has a life expectancy of six months or less. People can also continue to receive hospice care if they live longer and can also move out of hospice care if there is improvement in their disease or condition.
Like kidney supportive care, hospice builds on this same goal of comfort and dignity, but it is designed specifically for the final stage of life.
Support may include:
- Pain and symptom relief
- Assistance with personal care, such as bathing and getting dressed
- Nutritional guidance
- Psychological counseling and spiritual guidance
- Bereavement support for loved ones
Hospice care can take place at home, in a hospital or a special hospice facility. Your care team can discuss eligibility with you.
Talking to your family about hospice
Conversations about end-of-life care can be difficult, but being open with your loved ones helps them understand your wishes. Share what matters most to you, such as comfort, time at home or spiritual support. Encourage your family to ask questions and involve them in discussions with your care team if you feel comfortable. Clear communication can bring peace of mind and reduce stress for everyone.
Self-care for caregivers
Caring for someone at the end of life can be physically and emotionally demanding. It is just as important to care for yourself as it is to care for your loved one. Hospice teams can provide support to help caregivers stay strong.
Examples of caregiver self-care include:
- Eating well and getting enough rest
- Taking short walks or breaks to recharge
- Staying connected with friends and family
- Accepting help with meals, chores, or errands
- Joining a caregiver support group, online or in person
- Counseling to process emotions and stress
You are not alone
Supporting your mental and emotional health
Kidney disease affects more than your body. Living with kidney failure can be exhausting and scary. Your mental and emotional health is just as important as managing physical symptoms. Many patients express feeling hopeless and helpless as their kidneys stop working, but you don't have to go through this alone. Explore our emotional wellness resources and find support to help you focus on what matters most to you and your loved ones.