The Provider’s Role in Conservative Care and Advance Care Planning for Patients with ESRD

Conservative care (CC), also known as conservative management, is being gradually recognized as a viable therapeutic alternative for patients with advanced CKD in the United States (1,2). The Renal Physician Association’s clinical practice guideline on shared decision making in the appropriate initiation of and withdrawal from dialysis recommends to inform patients with stage 4 or 5 CKD and patients with ESRD about their prognosis and all treatment options, including CC (3). Although evidence is limited, current data suggest that patients with ESRD ≥75 years of age with high levels of comorbid conditions and/or poor functional status may not benefit from dialysis in survival and/or health–related quality of life. Indeed, hospitalization rates decrease and home deaths increase when these patients receive comprehensive CC compared with dialysis (4–7). Copyright © 2016 by the American Society of Nephrology