Hello, welcome to the University
of California San Diego Chronic Kidney Disease Program.
My name is Norma Reggev
and I'm a licensed clinical social worker.
Our healthcare team includes a nephrologist, pharmacist
nurse, social worker, and a dietician.
My role is to help educate patients learn
about kidney disease
and the treatment options available to them.
This is one module
of a six-part series discussing treatment options
for failing kidneys.
In this module, I will talk about conservative management.
Our goal is to help empower you with knowledge to
make informed decisions about your kidney treatment choices.
We know that needing to consider kidney treatment
options can be a big decision.
You have the right to decide how your kidney
failure will be treated
and you can choose conservative management instead
of dialysis or transplant.
Conservative management for kidney failure means
that your healthcare team continues your care
without dialysis or a kidney transplant.
The focus of care is
on your quality of life and symptom control.
It is a proactive choice that is usually decided
on when other options will not improve your quality of life.
What can I expect from conservative management?
Your healthcare team will help you create a plan to
meet your care needs.
This team may include a nephrologist
pharmacist, nurse, dietician, and a social worker.
You will continue to see your doctor regularly
and have lab work done, have ongoing management
of your symptoms such as anemia, swelling, nausea
blood pressure, or shortness of breath.
Your care plan may change
as your quality of life and health status changes.
Treatment goals
for conservative management can include avoiding treatments
and hospital stays that may worsen your quality of life.
This may mean fewer medical appointments, blood draws
and medicines, managing other health problems caused
by kidney failure like anemia
providing you with additional emotional support
helping preserve your kidney function
for as long as possible.
Management of your symptoms such
as nausea and poor appetite, optimizing your quality
of life and preparing for end of life care.
Here are some things to consider.
Those with kidney failure may choose no dialysis.
This is a personal choice.
Sometimes the patient and family don't agree on this.
It's important for patients to talk
about what they decide with their family and care team.
It's also important that the patient's wishes be respected.
Talking to other patients with kidney failure
and the choices they have made can be helpful.
Learning what treatment is really
like can help make the decision more clear.
Keep in mind
that conservative management won't cure kidney disease.
Your kidney function and how you're feeling
will influence the care you will receive.
Here's what a nephrologist has to say
about conservative management.
Here is Dr.
Tamara Robenzik, nephrologist
and palliative care specialist with uc, San Diego Health.
Really anybody can consider conservative kidney
management most often, however
conservative kidney management is considered
in patients who are less likely to derive a benefit
from dialysis.
Patients who fall
into that category include patients who are older
with multiple medical problems
and those patients might not live longer with dialysis
and might suffer greatly from a much more negative quality
of life on dialysis than they would without dialysis.
Really, it's about whether or not you would benefit
from conservative kidney management and
whether or not it's something that you want.
I would say the biggest consideration
for someone who's thinking
about conservative kidney management is thinking
about the quality of life associated
with dialysis compared to conservative kidney management.
We do know that most people who choose dialysis
either hemodialysis or peritoneal dialysis
will live longer with dialysis
than they will with conservative kidney management.
That benefit of living longer goes down greatly
in older patients and patients who have a lot
of medical problems that can be a little harder to predict.
However. So really, when thinking
about conservative kidney management, I really focus
in on the quality of life
and encourage patients to think about what quality
of life they're looking for as they look ahead.
So conservative kidney management avoids
unnecessary procedures, extra procedures and surgeries
more time spent in facilities
or in the hospital away from their family.
Conservative kidney management avoids those things.
So if you go down the path
of conservative kidney management, you don't have to worry
about a surgery for access placement.
You don't have to worry about going
to the clinic three days a week for dialysis.
You avoid the complications associated
with dialysis that often lead
to frequent hospitalizations and more time away from family.
And even in individuals who might consider
peritoneal dialysis that also requires a surgery
and requires nightly peritoneal dialysis at home.
Three days weekly.
Hemodialysis can can lead to a lot of symptoms.
It can lead to a lot of fatigue after dialysis.
A lot of patients, especially, again, older patients
more frail patients who go to dialysis are pretty wiped
out the whole day after dialysis.
So they essentially lose those days.
The dialysis days, they're spending them
either at the dialysis unit or recovering from dialysis.
So just you know, thinking
about the main patients who would benefit
from conservative kidney management, again, patients who
who are older
who have multiple other medical problems aside
from their kidney disease
they're the patients who would derive the most benefit
from that treatment path.
Patients who really feel as though the the cons
of dialysis are, are greater than the benefits.
Patients who feel as though going to
hemodialysis regularly doing peritoneal dialysis nightly
at home is a large burden would greatly
would negatively impact their quality
of life when it's a life that they can't imagine living.
Those are the patients really who should really
consider conservative kidney management.
There's another group
of patients that I haven't touched upon
and those are patients who might not be able to
safely receive dialysis, patients
with cognitive dysfunction and, and patients who might have
you know, severe other underlying medical problems such
as severe heart failure or severe liver disease, where
dialysis itself really might cause more harm than good.
Those patients as well would
would really benefit from conservative kidney management.
What does conservative
Kidney management involve?
It's not doing nothing.
It's really aggressively managing kidney disease
and the side effects of kidney disease doing
doing aggressive medical care up to actual dialysis.
So what it would u what it usually involves is
frequent visits with your nephrologist
and your nephrology team.
Often in advanced kidney disease
that can be as frequently as once a month.
It will involve taking a look at labs
taking a look at physical exam
and symptoms and adjusting medications to
target any symptoms you might be having
and also to help your kidneys work for as long as possible.
So it's still complete aggressive medical care just leading
up to dialysis.
As kidney disease progresses as symptoms progress
you might need to see your doctors more.
Sometimes other teams might be brought in
such as palliative care teams that really focus
on symptom management beyond what the
the general kidney team can provide.
And then as kidney disease progresses more
if patients become, have a harder time going to the doctor
start to have more symptoms
and feel more unwell when patients get closer
to the end of life.
At that point, your providers might start talking
to you about hospice care.
And hospice care really focuses on end of life care
on keeping you as comfortable as possible.
At that point
your doctors wouldn't be checking labs frequently
but would really be focusing on symptoms
and on keeping you home and comfortable
with your family at the end of your life.
I would add, you know, just for patients who
are considering conservative kidney management
to just really think about the pros and the cons
of dialysis and of conservative kidney management.
Some of this I've set already, but really thinking
about you know, what your goals are in life
what your goals of care are for your medical care
and what you are hoping for as time goes on.
The other important thing to remember is that you can always
change your mind.
So choosing conservative kidney management isn't
a decision that's that's set in stone.
You can, you can make a change.
So for some patients they might choose conservative kidney
management. They might decide that they don't want dialysis
and go down the path of conservative kidney management.
But if your goals change or symptoms become severe
to the point that you would like to try dialysis or switch
to dialysis, that is an option.
In the same regards, some people might choose dialysis
and they might start on hemodialysis or peritoneal dialysis
and at some point might decide that's no longer for them.
They don't want to continue renal replacement therapy
and those patients might choose to switch
to conservative kidney management.
So you can always change your mind
Since the goal of conservative management is to
keep you feeling well and maintaining your kidney function
for as long as possible.
There are some things you can expect
from your care team and with each phase
of your symptoms as your kidney disease progresses.
They typically occur
in three stages, mild, moderate, and advanced symptoms.
We will talk about each of these in greater detail.
When you're experiencing mild symptoms
your healthcare team will closely monitor your
kidney function and other organs that could be affected
by your kidney disease.
Make adjustments to your medication or start you
on new ones to help slow your kidney disease.
They will talk with you about diet
and lifestyle that could include what to eat
or drink or what to limit and ask you to complete
or update an advanced healthcare directive.
This is a legal document that states your care preferences
and who you would want to make medical decisions
for you in the event that you become sick
and cannot speak for yourself.
Once you begin to have moderate symptoms
your healthcare team may check in with you more often
about those symptoms, adjust your medicines to control them
discuss support options that might include palliative care
mental health, and other community care services.
Create a plan to avoid healthcare setbacks
or lessen their impact on you.
And finally, confirm your choice about dialysis.
If you're experiencing advanced symptoms
your healthcare team may adjust your medications to help you
from feeling sick, help you reassess your needs
for safety and comfort, ask you about hospice care
educate you about what to expect
as your disease progresses in the last months, weeks
and days of your life, and finally provide you
with the support for emotional aspects
of grief and thoughts about the future.
Let's compare conservative management versus dialysis.
Conservative management focuses on your quality
of life by also addressing your comfort
and health for as long as your kidney disease allows.
It can improve how you spend your time
with a goal of managing your symptoms and keeping you
out of the medical setting as much as possible.
This way you can spend more time
at home with your friends and family.
You will also spend less time
in the hospital and have fewer procedures.
It supports your caregivers
by helping them to understand your care needs.
Connects them to community resources for support
and assists in supporting you in your treatment choice.
And finally, some symptoms such as shortness of breath
and low energy can still be hard to control
despite treatment and medication.
Dialysis on the other hand
can extend your life giving you extra months or years.
It can improve certain symptoms
like poor appetite and leg swelling.
Dialysis also takes time and energy to keep
up a three day a week dialysis schedule.
And lastly, many people may experience symptoms
with dialysis such as pain and feeling wiped out.
As I touched on earlier, there are other services
your doctor may suggest when you choose conservative management
as you move along in your care.
They are palliative care or hospice.
Palliative care is specialized medical care
for people living with a serious illness.
This type of care is focused on providing relief
from the symptoms and stress of the illness.
The goal is to improve quality
of life for both the patient and the family.
This option is available
to you early on in conservative management.
Hospice is a program of care
and support for people at the end of their lives.
A trained team of health professionals
and caregivers provide symptom management and pain relief
as well as emotional and spiritual support.
The hospice team also provides support
to your family and caregivers.
It's important to remember that you always have a choice
and can change your mind at any time.
Some people choose conservative management
and never start on dialysis.
Others start with conservative management
change their minds and switch to dialysis treatment.
And finally, they're also those who return
to conservative management
after they've decided dialysis wasn't right for them.
None of these options is a wrong choice.
We know that deciding on treatment
for kidney failure is not an easy choice to make.
Today. We hope that you've learned a little bit more
about your option for conservative management.
Congratulations. You've completed the module
on conservative management.
Please check out our website
for additional educational modules in this series
on kidney failure and treatment options for failing kidneys.