(Mexico City) – – – Kidney Disease: Improving Global Outcomes concluded a landmark Controversies Conference on Supportive Care for patients with severe kidney disease who do not have the option of dialysis or transplantation. Such care is important worldwide for hundreds of thousands of patients and a concern for care givers in high and low-income countries.

The premise of the conference was that although kidney failure is treatable, some patients do not have access to kidney replacement therapy. Reasons for lack of access can be economic, inadequate health care resources, or personal inability to withstand arduous treatment. When these circumstances occur, health care teams must do everything they can to prolong life, provide comfort and manage symptoms. This care often includes members of the patient’s family.

Dr. Bertram Kasiske, co-chair of KDIGO, said, “KDIGO is proud to have sponsored this conference and developed recommendations that will be useful by patients, families and clinicians all over the world.”

“The overarching recommendation of this conference, which brought together sixty recognized international experts, was that this care is not optional or ancillary. It is part of the responsibility we have to treat kidney disease,” he added.

The conference was chaired by Dr. Sara Davison of Canada and Dr. Gregorio Obrador of Mexico. It is KDIGO’s 14th such conference where controversial or incompletely decided issues are debated by the global kidney community.

Conference attendees were engaged in five breakout groups discussing in depth what we do know about supportive care practices around the world, what we can do with this knowledge and where gaps in knowledge still persist. The breakout group topics included symptom screening, assessment and management, prognosis, conservative care, advanced care planning and shared decision-making and initiation, withholding and withdrawing dialysis. The conclusions of the group were presented in discussion sessions for input from all attending.

The following are major recommendations from the conference:


  • The need for supportive care for kidney patients is equal to that for cancer patients and should be available based on need, not prognosis, for patients at any stage of kidney disease.


  • Supportive care is an essential component of the continuum of quality care for CKD and ESKD patients and should be provided with sensitivity to cultural and religious values as well as patient and family comfort and dignity.


  • Research in supportive care is critical to build new knowledge so that patient outcomes can be improved.


  • Kidney patients have a high symptom burden, and treatment of their symptoms is a high priority for them. Nephrologists should routinely ask patients about symptoms so they can be identified and treated.


The leadership of KDIGO will take these recommendations into account and formulate a plan with the conference co-chairs to improve awareness, education and effective actions which will lead to better lives for these patients. Specific plans will be developed for each of the circumstances that lead to kidney failure without kidney replacement therapy. They will be applicable in countries will all levels of financial resources.

Dr. Kasiske went on, “This conference is the first of its kind in the world. In searching for background materials for this conference, we found a lot has been written over the years on the subject and we hope this conference adds to a comprehensive analysis of the issues. We will publish a Conference Report within six months and actively seek to disseminate its recommendations.”

KDIGO is a global not-for-profit organization incorporated in Belgium working independently to provide clinical practice guidelines and conference recommendations based on global science and the best evidence. All the experts at this Supportive Care Controversies Conference and in KDIGO itself are volunteers.

Implementation activities following this conference will include local meetings and follow-up conferences in many countries, electronic and hard copy tools for use by patients and clinicians, and presentations at dozens of conferences held by kidney organizations and other specialty groups.


For further information please contact KDIGO Communications at [email protected].

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