Do you know what treatment options are available if you have advanced kidney disease or kidney failure? Many people are told dialysis and kidney transplant are the only options; however, there may be a conservative management option that is often less discussed. 

Medical management without dialysis (MMWD) is a patient-centered approach that may allow for a better quality of life particularly for older patients or those with multiple health conditions. Learn more about what MMWD includes, its importance, and why doctors may not be discussing it enough.* 

What is MMWD?

Before starting dialysis, many patients have multiple long-term illnesses and already find their quality of life deteriorating. Their condition may also make them ineligible for transplant, so dialysis has been the main solution. 

Data from a 2020 report shows many patients, particularly those 80 years and older, may not survive any longer with dialysis than without it. After hearing this, some may opt to choose to live without dialysis, which would allow them to continue with their normal lives without dialysis-related disruption.

Alvin Moss, M.D., professor at West Virginia University School of Medicine, states: “Medical management without dialysis is about quality of life the way the patient defines it, as opposed to prolonged survival with dialysis.”

MMWD treatment includes:

• Preserving kidney function for as long as possible
• Managing symptoms, such as nausea and poor appetite
• Managing other health problems caused by kidney failure, such as anemia
• Maintaining quality of life for as long as possible
• Preparing for end-of-life care

Why Do Nephrologists Not Discuss MMWD More?

One research study found only 37% of nephrologists (“kidney doctors”) routinely discuss MMWD with their patients. Some experts believe improved conservation management education in medical school and a change in insurance reimbursement models would increase MMWD discussions with patients. 

Keren Ladin, Ph.D., MSc, Director of the Research on Ethics, Aging, and Community Health Lab, adds: “I believe if the case for supportive care was clearer, the clinical management and reimbursement were better established, and if there was more of a multidisciplinary team supporting patients who opted not to pursue dialysis, nephrologists may be more open to this approach.”

Why is MMWD important? 

For decades, the Institute of Medicine (IOM) has recognized the growing number of end-stage kidney disease (ESKD) patients. Many have limited survival possibilities and relatively poor quality of life on dialysis, but are not offered any other choice.

“Patients are hugely impacted by what they perceive as our explicitly offering them just one choice,” Catalina Sanchez-Hanson, M.D., told Nephrology News & Issues. “They appreciate it if we give them options. If we do not, and they do not want dialysis, it takes away their hope. My experience is that such patients live in fear of suffering because they believe they never can stop dialysis.”

Giving patients choices is a key part of happiness and may improve their quality of life, even at the end of their lives. 

*Neumann, M. E. (2021, January 19). Medical management without dialysis offers alternative therapy. Healio. https://www.healio.com/news/nephrology/20210112/medical-management-without-dialysis-offers-alternative-therapy 

Conservative Management for Kidney Failure. (2021, November 23). National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/kidney-disease/kidney-failure/conservative-management