A University of New Mexico kidney specialist says an alternative treatment to dialysis could be as effective and lead to a better quality of life for some patients with kidney disease.
But more patients need to know about the alternative, known as conservative management (CM), according to UNM's Mark Unruh, MD. He has conducted research showing that providers are often uncertain about which patients should pursue the therapy.
"The research points out that providers have uncertainty about an important treatment option – patients and their caregivers should be aware of this uncertainty," says Unruh, chief of the Division of Nephrology at the UNM School of Medicine. "There needs to be further research in this area so that we can better convey to patients and their caregivers their treatment options and outcomes."
When kidneys start to fail, doctors often start their patients on dialysis, which uses a machine to filter harmful wastes, salt and excess fluid from the blood. It’s a taxing procedure that can last from two to four hours and is often performed three times a week, usually in a dialysis unit.
“The vast majority of people of people in the U.S. with kidney failure will wind up on dialysis,” Unruh says, adding that about half a million people are on dialysis.
Meanwhile, those with late stage kidney disease may also be awaiting a kidney transplant, which can take years to procure.
Under the alternative, conservative management, kidney function is preserved with available medications, vitamins, dietary changes and exercise. Conservative management requires close monitoring by a nephrologist or primary care physician of the patient’s fluid levels and blood pressure. Studies suggest that older patients fare well with this treatment and can enjoy better quality of life and comparable survival rates to those treated with dialysis.
But many physicians are unfamiliar with this approach and lack the information to counsel patients and families effectively.
Unruh and colleagues from Vanderbilt University’s Center for Kidney Disease and the Nell Hodgson Woodruff School of Nursing at Emory University, surveyed doctors around the country to compare primary care physicians and nephrologists’ attitudes and knowledge of conservative management versus more traditional methods of treatment. The results were recently published in the Clinical Journal of the American Society of Nephrology.
They found that nephrologists and primary care doctors were equally likely to discuss conservative management with their patients. However, neither group felt comfortable determining who should or should not be encouraged to pursue this therapy. Primary care doctors were not as comfortable as nephrologists in discussing the outcomes of conservative management, the study found.
“I was surprised by the results,” Unruh says. “We’re talking to people about conservative kidney management, but we aren’t certain what to say.” Unruh thinks this might be due to the fact that “more needs to be done in research to define exactly what CM is and what it looks like.”
Managing health is a multifaceted affair that includes input from one’s culture, family, and belief system, Unruh says. However, it’s the physician’s responsibility to provide patients with alternatives. “We should convey to them their choices,” he says. “Are they aware of their options?”