Comprehensive Conservative Management as Rescue Therapy After Haemodialysis Failure: Two Case Reports

TL;DR

This paper presents two cases where conservative management improved survival and quality of life in elderly patients after hemodialysis failure.

Contribution

The study highlights the effectiveness of comprehensive conservative management as a rescue therapy in hemodialysis failure.

Findings

Both patients survived beyond 24 months with CCM after discontinuing hemodialysis.

CCM improved metabolic complications and quality of life while reducing hospitalizations.

The cases support CCM as a viable option for frail elderly patients with end-stage kidney disease.

Abstract

Background: Comprehensive conservative management (CCM) is a possible option in end-stage clinical disease, requiring multidisciplinary support and offering survival comparable to dialysis while improving quality of life in frail patients. Despite its potential benefits, CCM is often underutilized because nephrologists may perceive it as less effective compared to dialysis. We present two case reports of hemodialysis failure and of successful CCM. Case presentation: We present two case reports of elderly female patients—referred to as Patient 1 and Patient 2—who had multiple comorbidities but preserved urine output. Both patients, in accordance with their medical team, chose to discontinue hemodialysis due to poor treatment tolerance and declining overall health. They were successfully managed with CCM, leading to follow-up that revealed survival beyond 24 months, improvements in metabolic complications and quality of life, and a reduction in hospitalizations. Conclusions: These case reports demonstrate the effectiveness of dietary and medical management for end-stage kidney disease, particularly when dialysis negatively affects patients’ clinical conditions and quality of life. They also highlight the importance of considering CCM as a preferable option for frail elderly patients facing kidney failure.

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