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Date issued: October 2023

Review date: October 2025

Ref: 

Ref: B-493/JM/Renal/Conservative Kidney Management

PDF:  Your Guide to Conservative Kidney Management final October 2023.pdf [pdf] 798KB

You may have been to see your kidney (Renal) Consultant or a Chronic Kidney Disease Nurse and decided to follow a conservative management approach

to your advanced kidney disease. There are many ways in which we can support you, your relatives and carers.

This leaflet aims to give you some guidance on what support you will receive and how to best manage your condition.

What is a conservative approach to your chronic kidney disease (CKD)?

Conservative management is a treatment choice for chronic kidney disease without undergoing dialysis or a kidney transplant. Once a decision has been made for conservative kidney management, we will continue to give on-going care to you.

This will be provided by your Renal Team, your GP, Community Nurses, social care agencies and possibly the Palliative Care Team.

You can continue to attend appointments at hospital, or if you prefer the chronic kidney disease team (CKD) can provide you with telephone consultations. This can involve the management of your symptoms with medication and liaising with your GP and district nursing team.

Why do people choose conservative management ?

It is reasonable for some patients to choose, after consultation with their kidney team, not to have dialysis. Having dialysis can be burdensome, and for some patients with other medical conditions it may not increase their life expectancy. With conservative management you do not have dialysis or a transplant and your kidneys will slowly deteriorate until they are unable the function effectively at all. 

Can I change my mind?

It is important to remember as a kidney patient you have choices and should always discuss your individual needs and wishes with members of the renal team and those close to you. Everyone’s circumstances are different and personal choices and decisions are respected.

If you would like to return to clinic to re-evaluate your options we would be happy to arrange this.

Our aims:

•  To support you to maintain the best quality of life possible

•  To protect and maintain your remaining kidney function

•  To control and treat any symptoms of reduced kidney function

•  To give dietary advice when required through our renal dietitians

• To offer support and advice to you, family and friends

• To be there for you

Signs and symptoms you may be experiencing:

Symptoms of kidney disease vary from person to person, some people may not feel unwell whilst others do. Some symptoms may be due to other health conditions.

Common Symptoms may Include:

• Feeling tired

• Swelling of ankles / legs (fluid build up)

• Shortness of breath

• Lack of appetite / bad taste in mouth / nausea

• Itching / dry skin

• Muscle cramps (restless legs)

• Difficulty sleeping

• Constipation / diarrhoea/ trouble passing urine

•  Anxiety / depression

• Pain

If you are experiencing worsening symptoms please speak to a member of the CKD team or your GP.

What can you do to help look after your kidneys

A small amount of kidney function can go a long way to keeping you feeling well and free of major symptoms. There are ways to help maintain your kidney function which may slow down the progression of your kidney disease:

•  Take your medications as prescribed.

•  Maintain good control of your blood pressure, this can be monitored at home.

•  Eating healthily and reducing salt in your diet.

•  If you have diabetes - keeping good control of your blood sugars and checking them regularly is advised.

•  Keeping as active as possible.

•  Further damage can be caused to your kidneys by taking medications such as Ibruprofen, Nurofen and Voltarol tablets or creams.

• Speak with your GP or CKD Nurses if you need advice or have any concerns.

Other factors to consider

Anaemia Management

People with CKD aren’t always able to make new red blood cells. Red blood cells carry oxygen around your body to supply the cells and tissues and give you energy. You can be given various treatments to help with managing the symptoms and to make new red blood cells.

You may feel weak, tired, cold or short of breath. We may ask you to have a blood test so that we can check your iron levels and haemoglobin. This will guide us to see which treatment may be of benefit to you.

Iron

Your body needs iron, folic acid and vitamin B12 to make red blood cells. There are different ways that you may be given iron. People with CKD often can’t absorb the iron when given in tablet form, therefore we may invite you to have some iron directly given into one of your veins (infusion). This will often work quicker and correct the deficiency straight away.

Erythropoietin

Erythropoietin is often referred to as EPO. This is a hormone which is normally produced by healthy kidneys which stimulates the bone marrow to produce new red blood cells. When your kidneys start to fail you do not produce enough of this hormone naturally and may become anaemic. We may need to replace this with an artificial EPO, in the form of an injection which you can either administer yourself or go to your practice or district nurse.

Diet

The aim is a healthy, varied and enjoyable diet but some changes may be helpful. When the kidneys become weaker, their ability to remove waste products and balance the minerals is not as efficient. We recommend reducing your salt intake as this reduces fluid retention.

You have the opportunity to talk to our renal dietitians to get individualised dietary advice.

Fluid intake

It is important that you drink plenty of fluids to keep your kidneys hydrated. However, if you find that your feet or ankles are swelling or you are getting short of breath please contact either your GP or the CKD team and we can assess your swelling. In this case we may need to restrict your fluid intake or you may be prescribed a water tablet (diuretic) which will make you pass urine more frequently to get the excess fluid off your legs. 

How long will I keep well without dialysis?

This varies for each individual. There are many things that affect how long you will live, including if you have other illnesses and how well your kidneys are working. Your healthcare team will be able to discuss this with you in more detail and will explain the things that can affect this.

End of life

Should your kidney disease continue to decline, you may want to consider your wishes for end of life care. You may find it helpful to talk through your wishes with your family, friends and your GP, as they can also provide support and organise palliative care.

Your wishes about where you want to die will be honoured as much as possible, many people choose to die at home where they feel comfortable, or in a hospice or hospital setting.

Dying from kidney failure is a progressive process. People generally become drowsy, often slipping into a deep sleep before death, which is usually very peaceful.

Useful Contact Details

Derriford Hospital Switchboard           01752 202082

CKD Team                                           01752 430310                   

Mayflower  Renal Ward                       01752 431485

Renal Diabetes Team                          01752 431069

Renal Dietitian                                     01752 439961

Smoke free NHS helpline                    0300 123 1044