Conservative kidney management

Conservative kidney management (CKM) is a non-dialysis treatment strategy for end-stage kidney disease (ESKD) that is associated with survival and health-related quality-of-life outcomes comparable to those of dialysis in certain older adults living with frailty and significant co-morbidity. CKM seeks to establish an individual's care goals through shared decision-making, placing a particular emphasis on quality-of-life outcomes. Early in the disease course, CKM can emphasize the medical management of advanced chronic kidney disease to limit progression, whereas later the focus can shift to managing the unpleasant symptoms of ESKD and to advance care planning. This review provides an outline of current CKM evidence and practice.