Maximum Conservative Management: Alternative to Dialysis Therapy in CKD

Background: With improvement in dialysis techniques, increasing number of elderly and frail patients have started dialysis. However this may not improve life expectancy or quality of life. Maximum Conservative Management (MCM) has become a recognized form of treatment for patients who have made an informed decision about not to have dialysis. We describe our experience of providing MCM service at Queens Hospital, Romford, United Kingdom and it's effect on patient survival and maintaining quality and functional ability. We assessed the effect of this service in preventing hospital admissions by providing coordinated support from hospital and community and appropriate end of life planning. Methods: The conservative care clinic (CCC) was established in April 2021 at Queens Hospital, Romford. Once decision was made that patient is not suitable for dialysis referral was made to CCC. A Clinical Nurse Specialist would run the weekly clinic assessing wellbeing and complaints, review blood results, advise change in medications, refer to anaemia service, arrange admission if required and liaise with palliative care team in community if End of Life (EOL) care was imminent. Prospective data was collected about demography of the patients, frailty score, GFR, number of hospitalisations and survival after being registered in the clinic. Frailty score was calculated by Rockwood Frailty Scale. Results: 127 patients were seen between April 2021 and April 2025 including 63 female and 64 male patients . Average age was 83 years, (49 to 96). Median GFR at the time of first review was 13 (3-33) and median Frailty score was 7.(5-9). 53 patients seen in the clinic have so far died. Of those who died the average age at the time of death was 84.3 (50-97) years. Average follow up time before death in CCC was 15 (1-36) months. Median number of hospitalization was 1 (0-15). 2 patients during follow up started haemodialysis at patient request and 3 patients moved out of area under care of other hospitals. Conclusion: MCM provided a valuable alternative to dialysis for patients with CKD who choose not to start dialysis and prioritize maintaining a good quality of life. It offered symptom management, helped in avoiding hospital admissions and offered comprehensive approach to address their physical, emotional, and spiritual needs, and support them through the end of their journey.