Conservative Management for Chronic Kidney Disease: A New Approach

The American Society of Nephrology (ASN) recently released new Kidney Health Guidance (KHG) focused on conservative management for individuals experiencing kidney failure. This guidance, published in the Journal of the American Society of Nephrology, provides evidence-based support for a proactive and holistic approach to care that prioritizes a person’s values and goals alongside managing the symptoms and complications associated with kidney disease. The release, on March 18, 2026, marks a significant step in recognizing conservative management not just as an alternative to dialysis or transplantation, but as a valid and potentially preferred therapeutic option for many.

What is Conservative Management?

Conservative management, as defined by the ASN, is a standard-of-care model for people with kidney failure that focuses on preserving kidney function for as long as possible and managing the symptoms that arise as kidney function declines. It’s a proactive approach, meaning it doesn’t simply wait for complications to occur, but actively works to prevent them or mitigate their impact. This isn’t a new concept, but the new KHG provides a framework for consistent, high-quality care within this model. It emphasizes a collaborative approach, involving the patient, their care partners, and a team of healthcare professionals.

Traditionally, kidney failure treatment has centered around renal replacement therapies – hemodialysis, peritoneal dialysis, and kidney transplantation. However, these aren’t suitable or desirable for everyone. Conservative management offers a path for individuals who may not be candidates for these treatments, or who, after careful consideration of their values and quality of life, choose not to pursue them. It’s about aligning care with what matters most to the individual.

The Core Components of the New Guidance

The KHG centers around three core components: customized chronic kidney disease (CKD) care, symptom management, and navigating care transitions. Customized CKD care means tailoring treatment plans to each person’s unique circumstances, preferences, and goals. This involves shared decision-making, where patients are actively involved in choosing the course of their care. Symptom management addresses the wide range of physical and emotional symptoms that can accompany kidney failure, such as fatigue, pain, nausea, and anxiety. Finally, navigating care transitions focuses on ensuring smooth and supported transitions between different healthcare settings, including from hospital to home, or to palliative care or hospice. This is particularly vital as kidney failure progresses and end-of-life considerations become relevant.

The guidance specifically highlights the importance of engaging care partners – family members, friends, or other individuals who provide support to the patient. These partners play a crucial role in helping patients navigate the complexities of kidney failure and adhere to their care plans. Collaboration across disciplines, including nephrologists, primary care physicians, nurses, social workers, and palliative care specialists, is also emphasized.

What Does This Mean for Patients?

For patients facing kidney failure, this guidance means a greater emphasis on personalized care and a wider range of options. It acknowledges that there isn’t a one-size-fits-all approach to kidney failure treatment and that the best course of action depends on individual circumstances and preferences. It also means a greater focus on managing symptoms and improving quality of life, even as kidney function declines. The release of an Executive Summary alongside the full KHG is intended to accelerate the practical application of this model, making it more accessible to healthcare providers and patients alike. You can find more information about the guidance on the ASN website: https://www.asn-online.org/about/press/releases/ASN_PR_20260318_guidanceFINAL.pdf

Evidence and Limitations

The KHG is based on a review of the available evidence on conservative management for kidney failure. The ASN emphasizes that the guidance is intended to support best practices, but acknowledges that further research is needed to refine and improve the approach. The guidance doesn’t present new clinical trial data, but rather synthesizes existing knowledge and provides recommendations based on that synthesis. It’s important to note that conservative management is not a cure for kidney failure; it’s a way to manage the condition and improve quality of life. The effectiveness of conservative management can vary depending on the individual and the stage of their kidney disease. The executive summary details the evidence base supporting the three core components of the care pathway.

The Broader Context of Kidney Failure Care

Kidney failure affects millions of people worldwide. According to the Newswise article, people with kidney failure have a range of treatment options, including hemodialysis, peritoneal dialysis, and kidney transplantation. However, these options aren’t always feasible or desirable for everyone. Conservative management provides a valuable alternative for those who may not be suitable candidates for these treatments or who choose not to pursue them. It’s also important to recognize that kidney failure is often a chronic and progressive condition, and that conservative management can be implemented at any stage of the disease, not just when dialysis or transplantation are no longer options.

What Comes Next: Guidance Updates and Ongoing Research

The ASN plans to regularly review and update the KHG as new evidence becomes available. This is a dynamic process, and the guidance will evolve over time to reflect the latest advances in kidney care. Ongoing research is also needed to better understand the long-term outcomes of conservative management and to identify ways to improve the approach. Future studies may focus on developing more effective symptom management strategies, improving care coordination, and enhancing the support available to patients and their care partners. The ASN is committed to providing healthcare professionals with the tools and resources they necessitate to deliver high-quality conservative management care.