Living well with
Chronic Kidney Disease
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Alberta's Provincial Conservative Kidney Management Pathway
Living Well Without Dialysis
Patients over 75 years are a rapidly growing group starting dialysis. Frail, elderly patients managed conservatively (without dialysis) may live as long as patients who elect to start dialysis, with better preservation of physical/cognitive function and quality of life, no burden associated with the dialysis procedure, fewer admissions to acute care settings, and can remain in their home communities. Conservative Kidney Management (CKM) is planned, comprehensive, person-centered care for patients with end stage chronic kidney disease (CKD) for whom dialysis is unlikely to provide benefit based on informed and shared decision-making. CKM integrates palliative care principles (such as advance care planning (ACP), symptom management, psychosocial and family support) with interventions to delay progression and minimize complications of CKD and excludes dialysis.
The Conservative Kidney Management (CKM) pathway was launched in September 2016 to improve, standardize and evaluate care for patients with advanced chronic kidney disease who are unlikely to benefit from dialysis and have chosen CKM.
The CKM project involves stakeholders across Alberta including nephrologists, primary care providers, nursing and allied healthcare professionals, patients and families. It is a collaborative effort led by the Kidney Supportive Care Research Group that involves the Kidney Health Strategic Clinical Network TM of Alberta Health Services, Northern Alberta Renal Program (NARP), Southern Alberta Renal Program (SARP), and Alberta Innovates.
The Conservative Kidney Management pathway is a resource for patients and care providers to help in the management of kidney disease with a focus on quality of life, symptom management, and living well without dialysis.
This “mobile first”, interactive web-based tool empowers families, patients, clinicians and communities to develop individualized integrated communication and care plans aligned with patient's values, preferences and prognosis.
The pathway includes a decision aid that helps patients explore their treatment options and determine whether dialysis is right for them. The pathway also includes clinical guidelines on how to manage kidney failure and symptoms conservatively, education materials for patients and healthcare providers, and supportive tools such as crisis action plans and advanced care planning.
The CKM pathway coordinates kidney care with relevant primary and palliative care services, and will incorporate new initiatives currently being developed and rolled out under the direction of Alberta Health Services. The CKM provincial project committee regularly reviews the evidence and will continue updating the Clinical Pathway to reflect the best clinical evidence and stakeholders continue to provide feedback ensuring the pathway is responsive to end-users.
Explore the Pathway
The online clinical pathway and materials are publicly available to patients, families, and healthcare practitioners at: www.ckmcare.com
Highlighted Features of the CKM Pathway
Patient Decision Aid
Symptom Guidelines and Algorithms
Chronic Kidney Disease (CKD) Guidelines
As kidney function declines, one of the biggest choices for a patient with chronic kidney disease is whether to get dialysis or conservative kidney management (CKM). Information from the CKM pathway aided in the development and implementation of an interactive, web-based, patient decision aid (PDA) around the appropriate initiation of dialysis.
This tool is designed to help patients decide if CKM or dialysis is right for them based on their responses to nine key questions that explore their current health and preferences. The PDA provides a summary of treatment options, prognosis, and how each treatment aligns with the patient's stated preferences.
The patient decision aid is not intended as medical advice or to suggest treatment. However, it can be used to help facilitate treatment option discussions between patients, their family, and their healthcare team.
There are a number of common symptoms that patients with kidney failure might experience. These symptoms and their management might change over time. The CKM pathway has symptom management guidelines for healthcare professionals, including some that are specific to the last days to weeks of life.
Available Symptom Guidelines:
- Breathlessness
- Constipation
- Edema
- Fatigue and Sleep Disturbances
- Nausea and Vomiting
- Neuropathic Pain
- Nociceptive Pain
- Respiratory Secretions
- Restless Legs Syndrome
- Restlessness and Agitation
- Uremic Pruritus
The goal within conservative kidney management is to optimize quality of life, including addressing bothersome symptoms and maximizing physical function. This requires a slightly different approach to how we control blood pressure and manage complications of kidney failure such as anemia and phosphate levels. The CKM pathway outlines how the chronic kidney disease guidelines can be adjusted to better meet the needs of patients being cared for conservatively without dialysis.
Available CKD Guidelines:
- Acidosis
- Anemia
- Blood Pressure
- Calcium/Phosphorus
- Lipids
- Potassium
- Sodium/Fluid
- Vitamin D
Vision: To help people enjoy life while living with advanced chronic kidney disease by becoming a world leader in kidney supportive care research and clinical innovation.