Conservative Care Management in Chronic Kidney Disease: A Value for the Money?


  • Ana Farinha Coordinator of the Working Group of Conservative Care in CKD from Sociedade Portuguesa de Nefrologia; Nephrology Department, Hospital de Vila Franca de Xira, Vila Franca de Xira, Portugal Author
  • Pedro Barata Coelho Faculdade de Ciências da Saúde da Universidade Fernando Pessoa, Centro Académico Clínico do ICBAS‐CHUP, I3S‐Universidade do Porto, Porto, Portugal Author
  • António Teixeira Rodrigues Centre for Health Evaluation & Research/ Infosaúde, National Association of Pharmacies (CEFAR/ ANF), Lisbon, Portugal; Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3Bs PT Government Associate Laboratory, Braga/Guimarães, Portugal Author


Cost of Illness, Health Care Costs, Kidney Failure, Chronic/economics, Renal Insufficiency, Chronic/economics


End stage kidney disease (ESKD) is a potentially fatal disease that can be treated by one of three modalities: dialysis (hemodialysis or peritoneal dialysis) and kidney transplantation. Either of these options represents a heavy burden on health systems. Kidney transplantation has its own financial framework. Dialysis care, provided by public or private institutions is funded, since 2008, by a prospective bundle payment system called preço compreensivo (“comprehensive price”). In 2011, Direção Geral de Saúde (Directorate General of Health) proposed in “Norma 17” a fourth modality to handle ESKD: conservative care management (or kidney palliative care). This option focuses treatments on improving quality of life (and in some cases, time) in frail patients or patients who opt not to proceed to invasive treatment op‐ tions. “Norma 17” regulated the clinical framework for this proposal but its socioeconomic evaluation and subsequent reimbursement has not been established. This has become a barrier to its application by public and private providers. This work intends to reflect the individual, social and economic benefits of the implementation of the conservative care option so healthcare decision makers may support their decisions. The authors reflect on the limitations to analyze costs and results in end‐of‐life care and propose outcomes to compare dialysis and conservative care in ESKD.


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Conservative Care Management in Chronic Kidney Disease: A Value for the Money?. (2024). Portuguese Kidney Journal, 38(1), 35-42.

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