Table 1.

Living well with kidney disease and effective symptom management consensus conference recommendations

Domain	Specific recommendations
Perspectives on symptom burden from people with CKD	•People with CKD should be engaged by clinicians in identifying and prioritizing which symptoms affect their HRQOL, as well as determining the underlying causes and potential treatment options for these symptoms, in order to optimize symptom management.
	•A holistic approach to symptom evaluation and management by clinicians is needed that also considers genetic/biological (omics), behavioral, and environmental factors, as well as social determinants of health.
	•With respect to effective symptom management and across all aspects of kidney health, frequent and clear communication between the clinician and the person they are treating is crucial before, during, and after treatment, and should be ongoing throughout the journey of the person with CKD.
Unpleasant symptoms (e.g., CKD-associated pruritus) and symptom clusters in CKD	•Symptom management by clinicians should include detailed assessment of unpleasant symptoms, such as pruritus.
	•Further research into symptoms as clusters in CKD, is of paramount importance given that the treatment of 1 symptom in a symptom cluster may potentially alleviate other related symptoms.
Emotional symptoms, anxiety, and mental health in CKD	•Clinicians should be aware that emotional and psychological symptoms of kidney health have equal importance to physical well-being.
	•Early identification of unpleasant symptoms by clinicians is critically important, and both pharmacological and nonpharmacological treatment strategies including evidence-based psychological interventions should be considered in their management.
	•Systematic strategies for the screening, diagnosis, and treatment of unpleasant symptoms by clinicians should be culturally sensitive and take into consideration health literacy.
Effect of incremental dialysis and home dialysis on CKD symptoms	•KDRD, also known as or including the descriptors “end-stage” renal or kidney, and disease, disorder, or “failure,” should not be considered a single disease by nephrologists but as a spectrum with stages of evolution, and individualized and incremental dialysis transition can be used to assist the management of the kidney disorders as function gradually declines.
	•Using a personalized approach, home dialysis should be considered and discussed with a person with CKD by clinicians and/or dialysis nurses as a means to empower them by increasing their independence, freedom, and self-management.
	•Nephrologist and/or dialysis nurses, and persons with CKD and their care partners should advocate for a personalized and individualized approach to dialysis therapy, in lieu of a “one-size-fits-all” approach.
Conservative management and person-centered terminology in CKD	•Given that dialysis may not always exert the intended effect of restoring health in some people with CKD, conservative and preservative nondialytic management can also be considered by nephrologists as a comprehensive approach in the treatment of advanced CKD that focuses on the preservation of remaining kidney function and optimization of HRQOL.
	•Conservative and preservative management should include proactive symptom management by clinicians, dietary interventions under the direction of dieticians, advance-care planning by palliative care physicians, psychological support by psychologists and/or councilors, and social and family support from kidney support groups. All of these aspects should consider cultural and spiritual domains of care.
	•Person-centered terminology used by clinicians should be clear and precise and emphasize positive language that inspires hope, while terms with negative connotations including the descriptors “end-stage” and “failure” should be avoided.
	•Conservative and preservative management should not be equated as supportive care that results in a lack or rationing of care by clinicians.
Diversity, equity, and inclusion, and supportive care in CKD	•Prioritization of diversity, equity, and inclusion by all involved clinicians are critically important in the management of unpleasant symptoms in CKD.
	•Peer mentorship, involvement of CKD ambassadors within communities, and moderated kidney support groups have an important role in the supportive care of people with CKD as needed.

CKD, chronic kidney disease; HRQOL, health-related quality of life; KDRD, kidney dysfunction requiring dialysis.