Symptom control in comprehensive conservative care for chronic kidney disease

Over recent decades, the prevalence of chronic kidney disease (CKD) has risen markedly. In the terminal stage of the disease, renal replacement therapy (RRT) is traditionally recommended as the standard therapeutic approach. However, in older individuals with a high burden of comorbidities or substantial functional impairment, the benefits of RRT in terms of survival prolongation or improvement in quality of life become uncertain. In this context, comprehensive conservative kidney management (CKM) has emerged as a clinical alternative that is centered on the patient's needs, values, and preferences. CKM entails an active, nondialytic management strategy for CKD that incorporates palliative care principles, with emphasis on kidney supportive care, slowing disease progression, and symptom control. This article discusses the main symptoms experienced by patients with advanced CKD managed conservatively and provides practical recommendations for their clinical management.