Supportive kidney care in private practice nephrology: A quality improvement project

End-stage renal disease carries a high treatment burden, reduced quality of life, and limited survival in older adults. Patients with advanced kidney disease (stage 4-5 chronic kidney disease [CKD]) often initiate dialysis without fully understanding the prognosis or quality of life associated with different treatment options.

Supportive kidney care (SKC), or kidney palliative care, is not routinely provided in private nephrology practice. Early SKC can improve quality of life and support patients in living well with chronic illness.

Using the Plan-Do-Study-Act quality improvement framework, an evidence-based practice change project was implemented. A structured, nurse practitioner-led SKC clinic was developed using a pre-post design to increase documented prognosis education and advance care planning (ACP) for patients with advanced CKD. The project ran from September 2023 to January 2024.

Fifty-seven patients attended the clinic during the intervention. After the initial visit, 98.2% had documented prognosis education and completed ACP. Treatment preferences were clarified: 46 patients chose active medical management without dialysis, 10 chose dialysis, and 1 remained undecided. Among those choosing medical management, no hospitalizations occurred during the implementation phase.

Establishing a dedicated, nurse practitioner-led SKC clinic in private nephrology practice increased shared decision making and ensured goal-concordant care. This quality improvement project demonstrates that embedding SKC into private practice can empower patients and caregivers with prognosis education, ACP, and treatment aligned with their goals and values.