This sheet answers common questions about the joint kidney maximum conservative management (MCM) and palliative care clinic. If you would like further information, or have any worries, please do not hesitate to ask your nurse or doctor.

What is MCM?

Advanced kidney disease or kidney failure is when the kidneys no longer work to support your body’s needs. You might develop symptoms including a build-up of fluid in the body, itching, feeling sick or having a reduced appetite and restless legs. MCM is an active way of treating advanced kidney disease.

It focuses on maintaining a good quality of life that is right for you, but it never replaces your kidney function like dialysis does.

MCM involves:

  • Protecting your kidneys and trying to keep them working for as long as possible.
  • Managing any symptoms you may have with medication, dietary and fluid changes.
  • Helping you to live well with your kidney failure.

Why have I been referred?

All patients who decide to manage their kidney failure with MCM will be referred to the joint kidney MCM and palliative care clinic by their kidney team. In the clinic, you will meet one of the kidney clinical nurse specialists and one of the palliative care clinical nurse specialists.

This clinic provides the opportunity to discuss and document preferences and priorities about your care now and in the future. This is known as advance care planning. We will also assess your physical symptoms and emotional needs and make recommendations to manage these going forward.

Where will we see you?

You will be seen in your usual kidney centre either at Edgware Community Hospital, Royal Free Hospital, St Pancras Hospital or Tottenham Hale Kidney and Diabetes Centre. We aim to provide 45 minutes for each appointment.

What happens when you come to the clinic?

The nurses will ask how you are feeling and discuss any symptoms you might have, what tablets you are taking and your blood test results. They will talk to you, and those important to you, about your thoughts and how you would like to be looked after as your kidney function gets worse. They will also talk to you about how you would like to be cared for in the final months of your life. This can include writing down your wishes so that everyone involved in your care is aware.

How can I prepare for the clinic?

Please take time to think about what is important to you, in your life and your health. What do you feel is important for your loved ones and health care professionals to know about and are there any wishes you want to share with them?

Your kidney nurse or doctor can provide you with a patient information booklet called ‘Planning your future’ which can act as a guide.

If you have any of the following documents, which you are happy to share with us, please bring them with you:

  • Advance decision to refuse treatment.
  • Proof of lasting Power of Attorney.
  • Advance statement.
  • Living Will.
  • Preference for care document.

It is also helpful for you to bring an up-to-date medication list.

Can I bring someone with me?

Please feel free to bring along someone who is important to you, such as a family member or friend.

Comments/concerns regarding the service

If you would like to make any comments or have concerns regarding the service you receive, then you can speak to our PALS team or use the contact details below.