New Conservative Care clinic launches for patients of the renal program

For patients with kidney failure who decide to not have dialysis or a kidney transplant, a new clinic to help support them in their care journey has now opened at Kingston Health Sciences Centre. Known as the Conservative Care clinic, this model of care focuses on a patient’s quality of life, symptom management and end of life care goals in a time dedicated and fully resourced monthly clinic.

The creation of this clinic was inspired by models of care provided to palliative care patients with the goal of helping patients maintain their quality of life when not pursuing medical care options.

“Through this clinic we’re not looking at what we can do to improve patients kidney function but instead what we can do to give them the best quality of life and symptom management support possible,” says Angela Kulba, registered nurse with the regional renal program. “We want this clinic to provide comfort to our patients and to help reassure them and their family members that they’re not alone in this journey.”

Though conservative kidney care management has been offered through regular kidney care management for several years, the creation of this clinic ensures that there is dedicated time and appropriate resources in place to support conservative care, including clarified pathways on when to involve palliative care and the family doctor including when the transition should be with the handover to support final end of life care.

Before deciding to pursue conservative care, patients and their families are fully informed on all treatment options including dialysis, kidney transplant and home therapies.

“Several years ago we began research into what it would look like if you did not start on dialysis and found that there were some patients who may live just as long without it and have a different lifestyle as a result. For some patients who are fully informed on all of their options, conservative care can be a good fit,” says Dr. Welihinda, a nephrologist and palliative care doctor with the Conservative Care clinic. “We started to meet with patients and discuss their goals of care and talk with them on what end of life care looks like and how through conservative care we can best support patients, their families and their entire care team along that journey.”

Keeping the patient and family needs front of mind, the monthly clinic is offered both in-person and virtually, allowing patients who live further away from the physical clinic or for those for whom transportation is difficult, the ability to still receive conservative care management from the comfort of home.

The first clinic ran in April 2023 and already has 26 patients participating in it. Initial feedback from patients and families has been positive with expressions of appreciation at having the dedicated time in a more intimate environment focused on conservative care management.

For Kulba, who first saw the opportunity of this clinic based on her experience with palliative care patients, seeing it open is an especially important milestone as she heads into retirement and this was a final initiative that she helped to launch.

“All of this work, it’s all been for the patients and families; we were able to create a small, intimate clinic where they feel they are being heard and cared for and know that we’re going to help them on their care journey. I’m just so happy we were able to get this launched, it’s a passion in my heart and a good area of the multidisciplinary team to celebrate.”

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