Availability, Accessibility, and Quality of Conservative Kidney Management Worldwide

Clinical Journal of the American Society of Nephrology

Published: January 2021
DOI: https://doi.org/10.2215/CJN.09070620

Meaghan Lunney, Aminu K. Bello, Adeera Levin, Helen Tam-Tham, Chandra Thomas, Mohamed A. Osman, Feng Ye, et al.

People with kidney failure typically receive KRT in the form of dialysis or transplantation. However, studies have suggested that not all patients with kidney failure are best suited for KRT. Additionally, KRT is costly and not always accessible in resource-restricted settings. Conservative kidney management is an alternate kidney failure therapy that focuses on symptom management, psychologic health, spiritual care, and family and social support. Despite the importance of conservative kidney management in kidney failure care, several barriers exist that affect its uptake and quality.

Respondents from 160 countries completed the survey, and 154 answered questions pertaining to conservative kidney management. Of these, 124 (81%) stated that conservative kidney management was available. Accessibility was low worldwide, particularly in low-income countries. Less than half of countries utilized multidisciplinary teams (46%); utilized shared decision making (32%); or provided psychologic, cultural, or spiritual support (36%). One-quarter provided relevant health care providers with training on conservative kidney management delivery.

Overall, conservative kidney management is available in most countries; however, it is not optimally accessible or of the highest quality.

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