Nurse Practitioner-Led Comprehensive Conservative Kidney Care Program: Description of Program Implementation and Outcomes for Supportive Care for Persons with Chronic Kidney Disease.

This study evaluates the Comprehensive Conservative Kidney Care Clinic (CCKC), the first known U.S. nurse practitioner-led program for patients with advanced chronic kidney disease (CKD) choosing non-dialytic management in an urban safety-net setting. Retrospective analysis of 32 patients (mean age 74.6 years) over four years demonstrated the model's feasibility. While 81.3% remained on conservative management (CM), significant racial disparities emerged: 29.6% of Black patients transitioned to dialysis compared to 0.0% of White or Asian patients (p = 0.03). Furthermore, 70.8% of patients on CM utilized hospice, whereas none who initiated dialysis did. Qualitative findings suggest clinician framing strongly influenced patient choice. Despite the small sample size, the CCKC model effectively provides person-centered care, emphasizing the need for strategies addressing social determinants to ensure equitable access.