This pathway represents the best clinical evidence arrived at after careful consideration and does not override the individual responsibility to make decisions appropriate for each patient.

The guidelines were developed after comprehensive searches of the literature were conducted. Electronic databases include MEDLINE, CINAHL, UptoDate, the Cochrane Library, and Dynamed. Searches for other guidelines in nephrology and palliative care programs were also undertaken. Searches were conducted on a topic by topic basis with assistance from AHS Knowledge Management: Library Services. Results also incorporated prior literature searches done as part of Dr. Sara Davison’s research. Search terms included “Conservative Kidney Management”, “Conservative Kidney Care”, “End Stage Chronic Kidney Disease”, “Supportive Kidney Care”, “Kidney Palliative Care” and the topic in question, eg. “Dyspnea”.

All articles considered were prioritized depending on the strength of evidence. For example, Level I evidence (such as an RCT) would be included before Level IV evidence (such as another clinical practice guideline). An example of this is the inclusion of pramoxine, doxepin, and gabapentin for pruritus (Young, 2004; Pour-Reza-Gholi, 2007; Gunal, 2004) instead of sedating antihistamines as recommended in other guidelines (with no studies confirming their efficacy).

For many topics, there is very limited (if any) Level I - III evidence specific for conservatively managed ESKD patients. In this regard, then, articles were considered from the general CKD literature, at times including dialysis, geriatrics, and palliative care literature. Based on consensus-building in the provincial working group, recommendations were made taking the following into consideration: safety and symptom management, the patient’s GFR or overall condition, appropriate dose adjustments for kidney clearance, specific access to medications in Alberta, and so forth. Where there was discrepancy in terms of a particular dose or medication, the recommendation would err on the conservative side.

The symptom management guidelines all proceed from the least invasive/lowest risk interventions to the more invasive/higher risk interventions (eg. non-pharmcological interventions, then topical therapies, then systemic therapies). Dose adjustments and side effects are mentioned when significant. The CKD Management Guidelines are all prefaced with a “Guiding Principles” section that outlines the above considerations and encourages discussion.

  CKM Pathway References   - last updated Aug 2016

The CKM Care Pathway will be piloted in Northern and Central Alberta starting in Sept 2016 targeting outpatient kidney clinics. Although it is in the pilot phase, the pathway will be made available to the general public at that time and we are planning out the next phases of implementation which will include Southern Alberta as well as practitioners in other care settings such as Community Care. Please see our Events & Newsletters page for more information.

The pilot implementation will evaluate criteria across the 6 Dimensions of Quality and include, but are not limited to: