Myths & Questions

Conservative Kidney Management (CKM) is a treatment option for managing kidney disease. It involves:

  • treating the symptoms of kidney disease.
  • preventing or minimizing problems.
  • protecting and maintaining the remaining kidney function.
  • providing supportive medical and psychosocial care when needed.
  • helping you plan for the future.

Conservative Kidney Management does not include dialysis but does include all other aspects of kidney care and support. The goals of conservative kidney management are for you to live well without dialysis, to be as comfortable as possible, and to have a good quality of life.

Dialysis may not help everyone live longer or improve their quality of life. For some patients, the side effects of dialysis may even reduce quality of life or increase suffering. Dialysis will not treat other medical conditions (e.g., diabetes, heart conditions, arthritis, chronic pain).

Some people might feel that, in their specific situation, the burden of dialysis will outweigh the benefits. They might prefer non-dialysis care.

We know that some people are not as likely to do well on dialysis – that is, they are not likely to live longer or feel better. These people tend to:

  • have other serious medical conditions (especially heart disease and/or dementia).
  • require a lot of help with activities like bathing, dressing, and moving around.

For these reasons, conservative kidney management may be a better choice of treatment for some people.       

  • Talking about what is most important to you and what your healthcare goals are.
  • Receiving treatment that is focused on helping you reach those goals.
  • Learning about what symptoms to expect as your kidney function decreases and how they can be managed.
  • Having your symptoms regularly monitored and treated.
  • Having bloodwork done only as needed to meet your treatment goals.
  • Taking medicine that suits your needs and goals.
  • Talking about where you want to live as your illness progresses.
  • Developing an action plan to avoid unnecessary emergency room visits or hospital admissions.
  • Speaking with your loved ones and healthcare team about your wishes for your treatment choices in the future. This is called Advance Care Planning.
  • Connections with resources in your community to support you and your loved ones.

Yes. The decision is yours. Your healthcare team will do everything they can to make sure that you know what stage of illness you are at, how different treatments may affect your health and sense of well-being, and that you know about all of your treatment choices. We want to support you in the treatment choice that most closely meets your goals. 

Nobody knows the answer to this question. Many factors can affect how long you will live. Depending on how quickly your kidney function is decreasing, you may have weeks, months, or years ahead of you. Some factors that affect how long you will live include:

  • your kidney function/GFR (Glomerular Filtration Rate)
  • other illnesses such as diabetes and heart disease
  • your lifestyle (e.g., weight, exercise, diet, blood pressure)
  • your overall physical and mental condition

For most patients, it is important to involve family or important friends (your support people) when deciding if conservative kidney management is the right choice for them. It is also important to ask your healthcare team for information and support when you feel that you need it. If you wish, a meeting can be arranged with you, your family/support people, your doctor, social worker, and other healthcare providers. This meeting is to support you, answer questions, and talk about concerns. For many people, knowing their support people understand their wishes is a relief and gives them peace of mind.

Reaching your decision about CKM or talking about the final stages of kidney disease may be very emotional for you and your support people. Everyone reacts differently when they’re told their kidneys are failing—this is normal and expected.  Your healthcare team can help support you and your family.

This may depend on where you live and where you have been receiving your kidney care up until now.

If you have been attending a chronic kidney disease clinic, you might continue to attend this clinic and see your nephrology team. Some people with kidney disease are not connected to a kidney clinic, instead their kidney care is managed by their family doctor or a nurse practitioner. In either case, your healthcare team is committed to providing high quality conservative kidney management.

In general, members of your healthcare team might include dietitians, social workers, pharmacists, spiritual care providers, nurses, nurse practitioners, and doctors.

Many people who choose CKM live for months or even years. Your healthcare team might suggest ways we can try to protect and maintain your kidney function (slowing the progression of your kidney disease if possible).

Diet

Eating a healthy diet can help you stay well when your kidneys are not working properly. As your kidney function falls your appetite may decrease. A dietitian can help you make a plan that’s right for you.

Some people with kidney disease are advised to restrict certain foods in their diet, such as those high in potassium, phosphorus, and salt (sodium). These restrictions can make it hard for some people to enjoy eating. On the other hand, some of these things in food can make your symptoms worse (for example, phosphorus making you feel itchy, or too much salt (sodium) making you feel swollen or short of breath).

Your dietitian and care team can help you make a plan that focuses on your quality of life and what that means to you in terms of your diet.

Fluids

As kidney function decreases, your kidneys may not produce as much urine as before, and your body may become overloaded with fluid. Some people need to limit their fluids while other people can drink as much as they wish. If you have symptoms such as swelling and shortness of breath, you can speak with your care providers (in particular, a dietitian) about the amount of fluid you drink.

Like with your diet, your dietitian and care team can help you make a plan that focuses on your quality of life.

Some people are prescribed medicine (for example, Lasix; also called “water pills”) to help manage fluid in the body.

Drugs

Your kidneys can be easily damaged by certain medicines. Please check with your care provider before taking any new medications. It is important to keep an updated list of your medications so that all of your care providers know what you take. (This includes all medications, vitamins, supplements and alternative therapies.) You and your family play an important part in managing your kidneys and should be involved in treatment decisions. If you have side effects from your drugs or have questions about your treatment, please discuss them with your care team. Please also talk to your care team if you are having a hard time with:

  • affording your medicine
  • taking too many pills
  • swallowing your pills
  • knowing or remembering when to take your pills

Blood Pressure

Most people with chronic kidney disease are encouraged to have good blood pressure control (that is, blood pressure that is not too high). This can help protect your kidneys and health in the long run.

On the other hand, we don’t want your blood pressure to drop too low. Low blood pressure, or blood pressure that drops quickly when you stand up, can be dangerous and lead to falls.

For this reason, for patients who have chosen CKM, avoiding very low blood pressure may be more important than having very strict blood pressure control.

In addition to the primary care you receive from your GP or nurse practitioner (NP), the following teams might also be involved in your care:

Nephrology

Continuing Care teams

  • Homecare (including Palliative Homecare): consists of different professionals (nurses, respiratory therapists, occupational therapists, dietitians, social workers and more) who come to see you in your home and support you in your goals.
  • Supportive Living (described on the next page)
  • Facility Living (described on the next page)

Specialized Palliative Care Consult teams

  • These teams are made up of doctors and nurses who specialize in palliative care. They can help with symptom management, end of life planning, and making referrals for hospice/palliative care units when appropriate.

Specialized Geriatrics teams

  • These teams do in-depth assessments of older adults and make recommendations for care. Older adults often have multiple health conditions and can have complex concerns – these teams are made up of health professionals who specialize in this type of care. 

If you find that you need more assistance at home, Continuing Care services (such as homecare) can provide help to you and your family.

If it starts to look like remaining at home is not an option for you and your family, you can talk to your healthcare team about other possible options. These options would be accessed through Continuing Care services and might include:

Supportive Living offers a wide range of supports including meals, housekeeping, and recreational services. People there may need help due to physical or cognitive concerns. Home care resources are available on-site 24 hours a day.

Long Term Care is for people who have complex health conditions and who may also have physical mobility and cognitive challenges.

Hospice/Palliative Care is for individuals with a serious chronic disease or life-limiting illness. In Alberta, you have many options for where to get palliative and end of life care—your home, a hospital, a continuing care centre, or a hospice.

Working closely with your primary care provider, staff from Continuing Care would do an assessment of your wishes, your needs and your medical condition(s). They could then help you with your transition to another location of care.

Sometimes, people struggle to get by at home for as long as possible. The above assessments and planning take some time and cannot happen overnight. In order to avoid waiting until a crisis occurs, we encourage a lot of communication so that plans can be put into place at the right time.

There are resources and people available to help you and your family. Some of these might be with your current healthcare team, while others might be available to you as a referral if you need one.

Social workers can assist you and your family with the burdens of coping with illness and the stress that comes from living with kidney disease. They can help you access other services and resources in the community. If you have homecare services in place, you will most likely have access to a social worker or to other team members who can help in this regard.

Spiritual care providers offer spiritual, emotional and religious support to patients and families. They can also help you access other faith-based groups in your own community. A connection to a faith community might provide you with a great deal of support and comfort - consider connecting with one if this sounds important to you.

Your family physician or nurse practitioner might also be able to provide you with information about support services in your community.

In the last weeks to days of life, you might start or continue to have some common symptoms such as nausea/vomiting, itchiness, restless legs, sleep difficulties, pain, and trouble breathing. Your healthcare team can help you manage these symptoms.

When your kidney function gets very poor, you might start to experience other symptoms that we are not able to reverse. These include loss of appetite, muscle twitching, drowsiness, tiredness, and confusion. You might be spending much of your time resting and you might require a lot of help from your family and friends. 

If you and your family think that you need more help than what you can get at home, your healthcare providers can help you make another plan. This plan might include going to a place that provides palliative care, such as hospice. In this case, your care providers will help you access palliative care services in your community. If hospice is not an option, your care providers might suggest being admitted to a hospital for palliative care.

Your family doctor will most likely be overseeing your care at this point and working closely with homecare and palliative care as necessary.

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