"Conservative management is a valid alternative to dialysis therapy for a specific, well-defined group of patients," renal counsellor Maria Da Silva-Gane told the Second Pre-dialysis Forum Seminar.

"Our research has shown that in these high-risk, highly dependent patients, the decision to dialyse or not has little impact on survival and conservative therapy may provide a better quality of life."

But opting for conservative management must be a joint decision reached among the renal team, the patient and family, she stressed.

"We have found that extending the scope of our pre-dialysis programme has been the best way to achieve this goal," Maria Da Silva-Gane continued.

"We have enabled patients to make informed decisions about their future treatment, including whether or not to dialyse."

"It also allows us to plan from an early stage the location of their care to meet with their wishes and, through liaison with community agencies, arrange emotional support for both the patients and their relations," she said.

Full medical treatment of these patients is continued to maintain and stabilise these patients' existing renal function.

"It is well recognised that dialysis is a life-saving treatment but it can be a harrowing and traumatic experience for some patients.

"Our approach offers a viable alternative, which other units might like to copy," Maria Da Silva-Gane concluded.

The Second Pre-Dialysis Forum Seminar, again sponsored by Amgen, aimed to build on the success of the event held in York last year. There delegates discussed Pre-dialysis: Sharing the Vision, where they stressed the importance of the renal team promoting a multi-disciplinary approach to the care of patients.

This year's meeting in London addressed the theme "Facilitating Choice and Standards in Renal Care".

Consultant nephrologist Professor Anthony Nicholls of the Royal Devon and Exeter Hospital reinforced the importance of pre-dialysis programmes.

"Initiation of dialysis is still more of a clinical than biochemical decision, but early preparation and education will ensure a smooth transition from pre-dialysis to dialysis care," he told delegates.

"Pre-dialysis care has been fragmented or non-existent in the past.

"As a result, too many patients have been reaching dialysis unprepared or without prior medical care," he said

He predicted that the 3rd edition of the UK Renal Associations Standards Document would help the renal team correct these problems through addressing three key criteria: slowing disease progression; minimising co-morbidity; and maximising quality of life.

Anaemia management was one of the therapies which needed more widespread adoption in pre-dialysis patients, anaemia nurse specialist and chair of ANSA/UK Lesley Bennett added.

By increasing the haemoglobin level in our patients, left ventricular hypertrophy caused by anaemia will reduce, Lesley Bennett, who is at the Churchill Hospital, Oxford, told delegates.

The seminar was organised by the Forum's Steering Group, co-ordinated by renal nurse consultant Frances Coldstream. She said: "One of the key issues that came out of the York meeting was wanting to offer patients a viable option to dialysis, that being conservative management.

"We know that there are key players who have begun to develop this area and we wanted to give them a platform from where they could share and discuss their ideas. This also helped the Pre-dialysis Forum achieve its overall goals.

"I feel that today has succeeded in this aim," Frances Coldstream, who is at Guy's and St Thomas' Hospital NHS Trust, London, concluded.