Conservative Management

If you are thinking about having a transplant or starting dialysis, you may not need to read this page.

However, if you are unsure about whether dialysis or transplant are right for you, you might find the following information helpful.

What is conservative management?

It is reasonable for some patients to choose, after consultation with their kidney team, not to have dialysis. Having dialysis is onerous, and for some patients with other medical conditions it may not improve survival to any great extent. In  conservative management kidney function is not replaced. This means that you do not have dialysis or a transplant. The aim of conservative management is to maintain a good quality of life by prolonging kidney function, controlling symptoms, and supporting patients, their families and carers. Good planning and communication can help avoid inappropriate hospital admissions. When you are managed conservatively, there will be a core group of professionals  involved in your care. This will include kidney and palliative care teams, your GP and district nurses. The aim is to ensure that you are cared for in a way that suits you and meets your needs.

The aim of conservative management is:

1. Preventing and treating the symptoms of chronic kidney disease.

2. Protecting and maintaining remaining kidney function.

3. Planning for the future.

Preventing and treating the symptoms of chronic kidney disease

When your kidneys are no longer working properly, you start to experience symptoms caused by the build-up of toxins in your bloodstream. Symptoms can include:

  • tiredness
  • itching
  • pain
  • breathlessness
  • restless legs
  • sickness.

The symptoms of CKD can affect people in different ways. If symptoms do occur, they can usually be relieved by medical and/or non-medical treatments. It is important to tell the doctors and nurses looking after you if you are experiencing symptoms, so that they can be effectively treated.

Protecting and maintaining any remaining kidney function

The things that slow down the progress of kidney disease include:

  • managing your blood pressure
  • good blood glucose control if you have diabetes
  • preventing you having too much fluid in your body

As your illness progresses we will focus more on maintaining quality of life by controlling symptoms as they arise.

Planning for the future

This means thinking about how and where you want to be cared for when you become less well and at the end of your life. This might be your own home or a hospice.

Is any surgery involved?

There is no surgery involved.

Can I make an advance decision about treatment I do not want?

Yes, you can decide what treatment you do not want if, in the future, you are unable to make decisions yourself. Please ask your healthcare team for more information about doing this.

How long will I live?

This varies for each individual. There are many things that affect how long you will live, including if you have other illnesses and how well your kidneys are working. Your healthcare team will be able to discuss this with you in more detail and will explain the things that can affect this.

Can I change my mind once I have decided not to have dialysis?

Yes. We will support you in any decision you make. However, if you change your mind it might be because you are starting to feel unwell which may mean you need dialysis immediately. Starting dialysis in an emergency is not as easy as starting it in a planned way.

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