Conservative Kidney Management and kidney Supportive Care: Essential Treatments for Kidney Failure

Main Article Content

Sara N Davison Nicola Wearne Peace Bagasha Rene Krause

Abstract

Kidney supportive care (KSC) and conservative kidney management (CKM) are essential treatments for kidney failure (KF) but are nonexistent, poorly developed, and/or poorly integrated with kidney care across low-, middle-, and high-income countries. This article reviews the updated definitions and evidence for KSC and CKM and discusses who will most benefit from these treatments. Conservative kidney management involves highly individualized active treatment that comes with its own set of recommendations that focus predominantly on patient-specific goals and health-related quality of life.  The recommendations for managing the complications of kidney failure and the symptoms of pain, restless legs, uremic pruritus, nausea and vomiting, poor sleep and fatigue, and breathlessness in people receiving CKM are reviewed. Additional considerations for delivering CKM in low resource settings are discussed. 

Keywords: kidney failure, conservative kidney management, kidney supportive care, symptom management, analgesics

Article Details

How to Cite
DAVISON, Sara N et al. Conservative Kidney Management and kidney Supportive Care: Essential Treatments for Kidney Failure. Medical Research Archives, [S.l.], v. 11, n. 8, aug. 2023. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/4222>. Date accessed: 21 july 2024. doi: https://doi.org/10.18103/mra.v11i8.4222.
Section
Research Articles

References

1. Global, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. Feb 29 2020;395(10225):709-733. doi:10.1016/s0140-6736(20)30045-3
2. Davison SN, Jhangri GS, Johnson JA. Cross-sectional validity of a modified Edmonton symptom assessment system in dialysis patients: a simple assessment of symptom burden. Kidney Int. 2006;69(9):1621-1625. doi:10.1038/sj.ki.5000184
3. Davison SN, Jhangri GS. Impact of pain and symptom burden on the health-related quality of life of hemodialysis patients. J Pain Symptom Manag. 2010;39(3):477-485. Not in File.
4. Almutary H, Bonner A, Douglas C. Which patients with chronic kidney disease have the greatest symptom burden? A comparative study of advanced CKD stage and dialysis modality. J Ren Care. Jun 2016;42(2):73-82. doi:10.1111/jorc.12152
5. Janmaat CJ, van Diepen M, Meuleman Y, et al. Kidney function and symptom development over time in elderly patients with advanced chronic kidney disease: results of the EQUAL cohort study. Nephrol Dial Transplant. Apr 26 2021;36(5):862-870. doi:10.1093/ndt/gfz277
6. Obi Y, Qader H, Kovesdy CP, Kalantar-Zadeh K. Latest consensus and update on protein-energy wasting in chronic kidney disease. Current opinion in clinical nutrition and metabolic care. May 2015;18(3):254-62. doi:10.1097/mco.0000000000000171
7. Mujais SK, Story K, Brouillette J, et al. Health-related quality of life in CKD Patients: correlates and evolution over time. Clin J Am Soc Nephrol. Aug 2009;4(8):1293-301. doi:10.2215/cjn.05541008
8. Cabrera VJ, Hansson J, Kliger AS, Finkelstein FO. Symptom Management of the Patient with CKD: The Role of Dialysis. Clin J Am Soc Nephrol. Apr 3 2017;12(4):687-693. doi:10.2215/cjn.01650216
9. Solak B, Acikgoz SB, Sipahi S, Erdem T. Epidemiology and determinants of pruritus in pre-dialysis chronic kidney disease patients. International urology and nephrology. Apr 2016;48(4):585-91. doi:10.1007/s11255-015-1208-5
10. Mathur VS, Lindberg J, Germain M, et al. A longitudinal study of uremic pruritus in hemodialysis patients. Clin J Am Soc Nephrol. Aug 2010;5(8):1410-9. doi:10.2215/cjn.00100110
11. Rayner HC, Larkina M, Wang M, et al. International Comparisons of Prevalence, Awareness, and Treatment of Pruritus in People on Hemodialysis. Clin J Am Soc Nephrol. Dec 7 2017;12(12):2000-2007. doi:10.2215/cjn.03280317
12. Agarwal R, Light RP. Sleep and activity in chronic kidney disease: a longitudinal study. Clin J Am Soc Nephrol. Jun 2011;6(6):1258-65. doi:10.2215/cjn.10581110
13. Wu AW, Fink NE, Marsh-Manzi JV, et al. Changes in quality of life during hemodialysis and peritoneal dialysis treatment: generic and disease specific measures. J Am Soc Nephrol. Mar 2004;15(3):743-53. doi:10.1097/01.asn.0000113315.81448.ca
14. Chen JHC, Lim WH, Howson P. Changing landscape of dialysis withdrawal in patients with kidney failure: Implications for clinical practice. Nephrology (Carlton, Vic). Jul 2022;27(7):551-565. doi:10.1111/nep.14032
15. Foote C, Kotwal S, Gallagher M, Cass A, Brown M, Jardine M. Survival outcomes of supportive care versus dialysis therapies for elderly patients with end-stage kidney disease: A systematic review and meta-analysis. Nephrology (Carlton, Vic). Mar 2016;21(3):241-53. doi:10.1111/nep.12586
16. Verberne WR, Geers AB, Jellema WT, Vincent HH, van Delden JJ, Bos WJ. Comparative Survival among Older Adults with Advanced Kidney Disease Managed Conservatively Versus with Dialysis. Clin J Am Soc Nephrol. Apr 7 2016;11(4):633-40. doi:10.2215/cjn.07510715
17. Wong SPY, Rubenzik T, Zelnick L, et al. Long-term Outcomes Among Patients With Advanced Kidney Disease Who Forgo Maintenance Dialysis: A Systematic Review. JAMA Netw Open. Mar 1 2022;5(3):e222255. doi:10.1001/jamanetworkopen.2022.2255
18. Liyanage T, Ninomiya T, Jha V, et al. Worldwide access to treatment for end-stage kidney disease: a systematic review. Lancet. May 16 2015;385(9981):1975-82. doi:10.1016/s0140-6736(14)61601-9
19. Bello AK, Levin A, Lunney M, et al. Status of care for end stage kidney disease in countries and regions worldwide: international cross sectional survey. BMJ (Clinical research ed). 2019;367:l5873. doi:10.1136/bmj.l5873
20. Stanifer JW, Muiru A, Jafar TH, Patel UD. Chronic kidney disease in low- and middle-income countries. Nephrol Dial Transplant. Jun 2016;31(6):868-74. doi:10.1093/ndt/gfv466
21. Mayosi BM, Flisher AJ, Lalloo UG, Sitas F, Tollman SM, Bradshaw D. The burden of non-communicable diseases in South Africa. Lancet. Sep 12 2009;374(9693):934-47. doi:10.1016/s0140-6736(09)61087-4
22. Uganda National Household Survey 2019/2020. Uganda Bureau of Statistics 2021. Accessed June 17, 2023. https://www.ubos.org/wp-content/uploads/publications/09_2021Uganda-National-Survey-Report-2019-2020.pdf
23. Kapiriri L, Martin DK. Successful priority setting in low and middle income countries: a framework for evaluation. Health Care Anal. Jun 2010;18(2):129-47. doi:10.1007/s10728-009-0115-2
24. Norheim OF, Baltussen R, Johri M, et al. Guidance on priority setting in health care (GPS-Health): the inclusion of equity criteria not captured by cost-effectiveness analysis. Cost Eff Resour Alloc. 2014;12:18. doi:10.1186/1478-7547-12-18
25. Luyckx VA, Moosa MR. Priority Setting as an Ethical Imperative in Managing Global Dialysis Access and Improving Kidney Care. Semin Nephrol. May 2021;41(3):230-241. doi:10.1016/j.semnephrol.2021.05.004
26. White SL, Chadban SJ, Jan S, Chapman JR, Cass A. How can we achieve global equity in provision of renal replacement therapy? Bulletin of the World Health Organization. Mar 2008;86(3):229-37. doi:10.2471/blt.07.041715
27. Persad G, Wertheimer A, Emanuel EJ. Principles for allocation of scarce medical interventions. Lancet. Jan 31 2009;373(9661):423-31. doi:10.1016/s0140-6736(09)60137-9
28. Moosa MR, Maree JD, Chirehwa MT, Benatar SR. Use of the 'Accountability for Reasonableness' Approach to Improve Fairness in Accessing Dialysis in a Middle-Income Country. PloS one. 2016;11(10):e0164201. doi:10.1371/journal.pone.0164201
29. Kilonzo KG, Jones ESW, Okpechi IG, et al. Disparities in dialysis allocation: An audit from the new South Africa. PloS one. 2017;12(4):e0176041. doi:10.1371/journal.pone.0176041
30. Lunney M, Bello AK, Levin A, et al. Availability, Accessibility, and Quality of Conservative Kidney Management Worldwide. Clin J Am Soc Nephrol. Dec 31 2020;16(1):79-87. doi:10.2215/cjn.09070620
31. Connor S, Bermedo M, eds. Global Atlas of Palliative Care at the End of Life. Worldwide Palliative Care Alliance, World Health Organization; 2014. http://www.thewhpca.org/resources/global-atlas-on-end-of-life-care
32. Wearne N, Davidson B, Motsohi T, Mc Culloch M, Krause R. Radically Rethinking Renal Supportive and Palliative Care in South Africa. Kidney international reports. Mar 2021;6(3):568-573. doi:10.1016/j.ekir.2020.11.024
33. Davison SN, on behalf of the Kidney Supportive Care Research Group: Conservative Kidney Management Care Pathway. Accessed April 21, 2021, www.ckmcare.com
34. Davison SN, Tulupa B, Wasylynuk B, Siu V, Sinnarajah A, J T. Recommendations for the Care Patients Receiving Conservative Kidney Management: Focus on Management of Chronic Kidney Disease and Symptoms. CJASN. 2019;14(2)doi: https://doi.org/10.2215/CJN.10510917
35. Kutner JS, Blatchford PJ, Taylor DH, Jr., et al. Safety and benefit of discontinuing statin therapy in the setting of advanced, life-limiting illness: a randomized clinical trial. JAMA internal medicine. May 2015;175(5):691-700. doi:10.1001/jamainternmed.2015.0289
36. Benetos A, Rossignol P, Cherubini A, et al. Polypharmacy in the Aging Patient: Management of Hypertension in Octogenarians. JAMA. Jul 14 2015;314(2):170-80. doi:10.1001/jama.2015.7517
37. Muller M, Smulders YM, de Leeuw PW, Stehouwer CD. Treatment of hypertension in the oldest old: a critical role for frailty? Hypertension. Mar 2014;63(3):433-41. doi:10.1161/hypertensionaha.113.00911
38. Musini VM, Tejani AM, Bassett K, Wright JM. Pharmacotherapy for hypertension in the elderly. The Cochrane database of systematic reviews. Oct 07 2009;(4):CD000028. doi:10.1002/14651858.CD000028.pub2
39. KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease. Kidney Int. Mar 2021;99(3s):S1-s87. doi:10.1016/j.kint.2020.11.003
40. KDIGO Clinical Practice Guideline for Anemia in Chronic Kidney Disease. Kidney International. 2012;2(4):S279-S335.
41. Kopple JD, Kalantar-Zadeh K, Mehrotra R. Risks of chronic metabolic acidosis in patients with chronic kidney disease. Kidney Int Suppl. Jun 2005;(95):S21-7. doi:10.1111/j.1523-1755.2005.09503.x
42. KDIGO. Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. 2013.
43. Ikizler TA, Burrowes JD, Byham-Gray LD, et al. KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update. American Journal of Kidney Diseases. 2020;76(3):S1-S107. doi:10.1053/j.ajkd.2020.05.006
44. WHO's cancer pain ladder for adults. World Health Organization. http://www.who.int/cancer/palliative/painladder/en/
45. Barakzoy AS, Moss AH. Efficacy of the world health organization analgesic ladder to treat pain in end-stage renal disease. CJASN. 2006;17(11):3198-3203. Not in File.
46. Davison SN. Clinical Pharmacology Considerations in Pain Management. Clin J Am Soc Nephrol. 2019;14(6):917-931.
47. Davison SN, Tupala B, Wasylynuk BA, Siu V, Sinnarajah A, Triscott J. Recommendations for the Care of Patients Receiving Conservative Kidney Management: Focus on Management of Chronic Kidney Disease and Symptoms. Clinical journal of the American Society of Nephrology : CJASN. 2019;doi:10.2215/CJN.10510917
48. "Weak" opioid analgesics. Codeine, dihydrocodeine and tramadol: no less risky than morphine. Prescrire international. Feb 2016;25(168):45-50.
49. Seya MJ, Gelders SF, Achara OU, Milani B, Scholten WK. A first comparison between the consumption of and the need for opioid analgesics at country, regional, and global levels. J Pain Palliat Care Pharmacother. 2011;25(1):6-18. doi:10.3109/15360288.2010.536307
50. Cleary J, Powell RA, Munene G, et al. Formulary availability and regulatory barriers to accessibility of opioids for cancer pain in Africa: a report from the Global Opioid Policy Initiative (GOPI). Ann Oncol. Dec 2013;24 Suppl 11:xi14-23. doi:10.1093/annonc/mdt499
51. Global Opioid Policy Initiative. European Society for Medical Oncology. Accessed May 3, 2023, https://www.esmo.org/policy/access-to-cancer-medicines-and-technologies/accessibility-and-availability-of-medicines-and-technologies/global-opioid-policy-initiative
52. Cherny NI, Cleary J, (Ed.). Opioid availability and accessibility for the relief of cancer pain in Africa, Asia, India, the Middle East, Latin America and the Caribbean: Final Report of the International Collaborative Project [Special issue]. Ann Oncol. 2013;24(Suppl 11):ii-xi64.
53. WHO Model Lists of Essential Medicines - 22nd List. World Health Organization. Accessed May 3, 2023, https://www.who.int/groups/expert-committee-on-selection-and-use-of-essential-medicines/essential-medicines-lists
54. Essential palliative care package for Universal Health Coverage. African Palliative Care Association; 2019. Accessed May 3, 2023. https://palprac.org/wp-content/uploads/2019/11/Palliative-care-in-Universal-Health-Care-package-.pdf
55. Hercz D, Jiang SH, Webster AC. Interventions for itch in people with advanced chronic kidney disease. The Cochrane database of systematic reviews. Dec 7 2020;12(12):Cd011393. doi:10.1002/14651858.CD011393.pub2
56. Wearne N, Krause R, Davidson B, Brennan F. Renal palliative and supportive care in South Africa – a consensus statement. African Journal of Nephrology. 05/11 2020;23(1):86-107. doi:10.21804/23-1-4009
57. Ashuntantang G, Osafo C, Olowu WA, et al. Outcomes in adults and children with end-stage kidney disease requiring dialysis in sub-Saharan Africa: a systematic review. Lancet Glob Health. Apr 2017;5(4):e408-e417. doi:10.1016/s2214-109x(17)30057-8