Treatment helps kidney failure patients maintain quality of life

EDMONTON — Alberta Health Services (AHS) is improving the quality of life for patients with advanced kidney failure with the introduction of the Conservative Kidney Management (CKM) pathway.

CKM is a treatment option focused on improving symptoms and quality of life for the frail and elderly; patients with multiple and complex health issues; and patients near the end of life. The pathway doesn’t include dialysis but does include all other parts of kidney care; using diet, exercise and medications to slow the progression of kidney failure and treat the complications.

“The aim of Conservative Kidney Management is to help patients live well without dialysis with a good quality of life by focusing care on controlling symptoms and optimizing their ability to function,” says Dr. Sara Davison, nephrologist with the Northern Alberta Renal Program and lead for the Kidney Supportive Care Research Group and CKM Pathway initiative.

“Dialysis may not help everyone live longer or improve their quality of life. For some frail people with lots of other health problems, the side effects of dialysis may make them feel worse and lower their quality of life. Patients have the right to choose the care that best meets their needs, values and preferences.”

Patients managed without dialysis may live as long as patients who elect to start dialysis with better preservation of physical and cognitive function, no burden associated with the dialysis procedure, fewer admissions to hospital, and the opportunity to be cared for in their own communities.

Typically, patients receiving dialysis visit a clinic three times a week, with each treatment taking approximately four hours. Complications can include infection, confusion, low blood pressure causing nausea and dizziness, and abdominal pain.

There is no cure for kidney failure; the treatment options are transplantation, dialysis or CKM. Dialysis is recommended for most patients with kidney failure who do not have other serious health problems. Dialysis will lessen complications of kidney failure and may keep them healthier and alive longer.

The pathway was introduced a year ago to improve, standardize and evaluate the care for patients who choose CKM. It includes a decision aid that helps patients explore their treatment options and determine whether dialysis is right for them. The pathway also includes clinical guidelines on how to manage kidney failure and symptoms, education materials for patients and healthcare providers, and tools such as a crisis action plan and having conversations about the end-of-life.

The CKM pathway is being piloted in four outpatient kidney clinics in Edmonton and northern Alberta, with plans to implement across the province in 2018. Since implementation, more than 200 patients have used the pathway.

Patient Tom McGee, 80, has been using CKM for three years after his family doctor discovered his declining kidney function and referred him to the renal clinic.

“They discussed Tom’s options with us right away at the clinic and he chose not to have dialysis,” says McGee’s wife Chris. “He didn’t want to spend every second day at the dialysis clinic. Quantity is not the key thing; it’s quality of life.”

Tom has lab tests every month and the results go to his nephrologist and dietitian, who then review his medications and diet with him.

The McGees make the most of Tom’s freedom and are frequent travellers.

“We take advantage of the time we have together,” says Chris. “We’re able to go to Vancouver or Jasper to visit family and friends, and not have to worry about getting to a clinic.”

Alberta Health Services is the provincial health authority responsible for planning and delivering health supports and services for more than four million adults and children living in Alberta. Its mission is to provide a patient-focused, quality health system that is accessible and sustainable for all Albertans.

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