What is Kidney Supportive Care?
Kidney supportive care is both a philosophy and a set of health services designed to support patients with kidney disease. It is focused on delivering patient-centered care that improves health-related quality of life throughout the care continuum.
In December 2013, Kidney Disease: Improving Global Outcomes (KDIGO), an independent and international body that outlines best clinical practices for kidney disease, held one of its Controversies Conferences in Mexico City. These conferences are built around a specific topic important to patients and providers and give focus to the event. That year, the topic was Supportive Care in Chronic Kidney Disease (CKD). The participants summarized the state of knowledge at the time for the purpose of developing a workplan to guide clinical and research activities focused on improving the outcomes of people living with advanced CKD, including those on dialysis.
One of the most important results of the conference was a definition. KDIGO defined kidney supportive care as:
Services that are aimed at improving the health-related quality of life for patients with established CKD, at any age, and can be provided together with therapies intended to prolong life, such as dialysis. |
There are a couple key components to this definition.
- Patient-centered care. Kidney supportive care seeks a collaboration between patient and provider that ensures the patient's wishes are respected and prioritized.
- Multiple care pathways within a between patient journeys. Kidney supportive care aims to inform patients of existing care modalities and actively support patients in an interdisciplinary, continuous manner.
In 2024, the Conservative Kidney Management/Kidney Supportive Care Workgroup of the International Society of Nephrology continued to build on the work of KDIGO by publishing an article presenting definitions for conservative kidney management and kidney supportive care, describing their core components, and discussing some of the additional considerations for delivering conservative kidney management and kidney supportive care in low resource settings.
Palliative Care vs Kidney Supportive Care
There are significant similarities and important differences between kidney supportive care and palliative care. In general, kidney supportive care looks to apply the principles of palliative care to the entire continuum of care for patients with kidney disease.
Palliative Care* | Kidney Supportive Care |
|---|---|
| Improves health-related quality of life of patients and their families | Improved health-related quality of life of patients with established chronic kidney disease |
| Focuses on patients facing life-threatening illness | Applies palliative care principles throughout the continuum of care for chronic kidney disease and end-stage kidney disease |
| Encompasses both specialty palliative care (by certified specialists) and generalist palliative care (by any provider, also known as primary palliative care) | Usually refers to generalist palliative care/primary palliative care as provided by the nephrology team, who may then consult or refer to specialty palliative care teams as needed |
*As defined by the World Health Organization
Core Elements of Kidney Supportive Care Programming
Kidney supportive care is a rapidly evolving discipline whose outer bounds continue to adapt to meet the needs of patients. There are a few core elements, though, that successful programs often contain:
- Shared Decision-Making when Determining Care Pathway
Kidney supportive care ensures patients are well-informed about the different treatment modalities appropriate for them, including but not limited to dialysis. These collaborative discussions should consider key information like the patient's health-related quality of life goals and the patient's prognosis.
- Care pathways may involve trials of dialysis, in-home dialysis options, no dialysis, or may involve a combination of treatment options as patients progress through their care journey.
- Some patients may choose to forego dialysis due to personal wishes. Active Medical Care without Dialysis (also known as Conservative Kidney Management) is an option to support patients in the clinic setting. Shared decision-making continues as providers help patients explore the pros and cons of foregoing or withdrawing from dialysis care.
- Ongoing Symptom Management
Patients with chronic kidney disease may experience a variety of symptoms or have other medical conditions (comorbidities). Clinicians practicing kidney supportive care take a holistic, continuous, and collaborative approach to caring for patients.
- Advance Care Planning
Advance Care Planning is important regardless of CKD stage. Understanding and documenting patients' values and wishes is imperative so care providers can honor those wishes. Kidney supportive care also helps patients and caregivers prepare for end of life transitions.
Resources to Support Further Learning and Implementation
Explore the Coalition's free and publicly available Resources Library. In this library, you will find a variety of materials for different audiences (patients and caregivers, clinicians) and different objectives (implementing specific components of kidney supportive care vs larger scale change management).
References
In addition to those sources linked above, this page is adapted from the Overview section of Palliative Care in Nephrology, which was edited by current and former Executive Committee members of the Coalition for Supportive Care of Kidney Patients.