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Kidney Week

Abstract: SA-PO744

Identification and Prioritization of Quality Indicators for Conservative Kidney Management

Session Information

  • Geriatric Nephrology
    October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Geriatric Nephrology

  • 1100 Geriatric Nephrology


  • Harrison, Tyrone, University of Calgary, Calgary, Alberta, Canada
  • Tam-Tham, Helen, University of Calgary, Calgary, Alberta, Canada
  • Hemmelgarn, Brenda, University of Calgary, Calgary, Alberta, Canada
  • James, Matthew T., University of Calgary, Calgary, Alberta, Canada
  • Sinnarajah, Aynharan, University of Calgary, Calgary, Alberta, Canada
  • Thomas, Chandra Mary, University of Calgary, Calgary, Alberta, Canada

Conservative kidney management (CKM) is comprehensive patient-centred care for individuals with end-stage renal disease (ESRD) without renal replacement therapy. CKM focuses on delaying progression of kidney disease, symptom management, and frequent communication and support. Currently there is no consensus as to what constitutes high quality CKM. We aimed to develop a consensus-based set of quality indicators (QIs) for the conservative management of ESRD.


A nominal group technique study of patients and caregivers was used to identify and prioritize QIs for CKM, guided by QIs reported in the literature. A Delphi process with healthcare providers was used to rate the QIs using a 9-point Likert scale, in a series of four rounds, until consensus was reached based on pre-specified criteria. Consensus for the QIs in the Delphi process was met if the mean rating on the Likert scale was ≥7.0 and percent agreement was >75%.


Sixteen patients and caregivers from Calgary, Canada participated in two nominal group meetings. Ninety-one multidisciplinary healthcare providers from 10 countries took part in the Delphi process. Patients and caregivers prioritized QIs focused on quality of dying and access to CKM personnel. Healthcare providers prioritized 99 QIs (out of a total 160) that met consensus criteria for inclusion. Nearly all (98.7%) participating healthcare providers indicated that quality of CKM delivery was important to measure, though less than a third (32.1%) measured quality in their provision of CKM. The most highly rated QI in the Delphi process was the "percentage of patients that die in the place they desire." There were several limitations as participants were largely from high-income, English-speaking countries, and most had structured CKM programs in place.


Quality of CKM care is important to patients, caregivers, and healthcare providers, though differences in priorities were noted. CKM programs and healthcare providers can use this international consensus-based QI list to evaluate and modify their CKM program delivery.