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Am J Kidney Dis. 2018 Oct 25. pii: S0272-6386(18)30937-5. doi: 10.1053/j.ajkd.2018.08.014. [Epub ahead of print]

Identification and Prioritization of Quality Indicators for Conservative Kidney Management.

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Departments of Medicine, University of Calgary, Calgary, Alberta, Canada; Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Family Medicine, University of Calgary, Calgary, Alberta, Canada; Oncology, University of Calgary, Calgary, Alberta, Canada.
Departments of Medicine, University of Calgary, Calgary, Alberta, Canada. Electronic address:



Conservative kidney management is holistic patient-centered care for patients with kidney failure that focuses on delaying the progression of kidney disease and symptom management, without the provision of renal replacement therapy. Currently there is no consensus as to what constitutes high-quality conservative kidney management. We aimed to develop a set of quality indicators for the conservative management of kidney failure.


Nominal group technique and Delphi survey process.


16 patients and caregivers from Calgary, Canada, participated in 2 nominal group meetings. 91 multidisciplinary health care professionals from 10 countries took part in a Delphi process.


Nominal group technique study of patients and caregivers was used to identify and prioritize a list of quality indicators. A 4-round Delphi process with health care professionals was used to rate the quality indicators until consensus was reached (defined as a mean rating on the Likert scale ≥7.0 and percent agreement >75%). Quality indicators that met criteria for consensus inclusion in the Delphi survey were ranked, and comparisons were made with nominal group priorities.


99 quality indicators met consensus criteria for inclusion. The most highly rated quality indicator in the Delphi process was the "percentage of patients that die in the place they desire." There was significant discordance between priorities of the nominal groups with that of the Delphi survey, with only 1 quality indicator being shared on each groups' top 10 list of quality indicators.


Participants were largely from high-income English-speaking countries, and most already had structured conservative kidney management programs in place, all potentially limiting generalizability.


Quality of conservative kidney management care is important to patients, caregivers, and health care professionals. However, discordant quality indicator priorities between groups suggested that care providers delivering conservative kidney management may not prioritize what is most important to those receiving this care. Conservative kidney management programs and health care providers can improve the applicability of this consensus-based quality indicator list to their program by further developing and evaluating it for use in their program.


Conservative kidney management; Delphi process; caregiver perspective; end-of-life care; kidney failure; nominal group technique; palliative care; patient perspective; patient-centered care; prioritization; qualitative research; quality indicators; quality of care; supportive management


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