Background: Conservative kidney management is the active healthcare management of advanced kidney disease without the provision of kidney replacement therapy. While there is increasing evidence that older, multimorbid patients may not benefit from dialysis, survival estimates for patients on a conservative pathway vary.

Aim: To assess the survival in conservatively managed patients known to a kidney supportive care (KSC) service.

Methods: Retrospective analysis of conservatively managed patients attending a KSC clinic between February 2016 and March 2023. Patients' demographics, Charlson Co-morbidity index score (CCI), estimated glomerular filtration rate (eGFR) at consecutive appointments and date of death were collected. Patients were excluded if there were insufficient records. Survival was calculated from referral, and eGFR <10 mL/min/1.73 m2.

Results: A total of 403 conservatively managed patients were included in the analysis. The median age at referral was 80 [IQR:75–85] years; 50.9% were female, with a mean CCI of 7.76 [SD 1.88]. The mean eGFR at time of referral to KSC was 17.12 [SD 7.11]. Overall, 63% of patients survived 12 months. For those who died during the follow up period, the median survival from referral was 319 days [IQR: 191–582]. From the time at which their eGFR reached <10 mL/min/1.73 m2, the median survival was 174 days [IQR: 65–417], with 31% surviving more than 12 months.

Conclusions: Our results demonstrate that conservatively managed patients survived up to a year or longer, similar to current literature. This helps to guide clinicians in making future planning decisions with their patients. Future prospective studies are required to further understand the survival of this patient cohort.