{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T04:35:24Z","timestamp":1777955724379,"version":"3.51.4"},"reference-count":22,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2014,4,1]],"date-time":"2014-04-01T00:00:00Z","timestamp":1396310400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Health (London)"],"published-print":{"date-parts":[[2014,11]]},"abstract":"<jats:p>Chronic kidney disease stage 5 is a global health challenge in the context of population ageing across the world. The range of treatment options available to patients at all ages has increased and includes transplantation and dialysis. However, these options are often seen as inappropriate for older frailer patients who are now offered the option of conservative kidney management, which is presented as a non-invasive alternative to dialysis, involving symptom management and addressing psychosocial needs. In this study, we conducted qualitative interviews with 26 close persons caring for someone with chronic kidney disease stage 5 in the United Kingdom to investigate how conservative kidney management interacted with implicit ideas of ageing, in both the experience of conservative kidney management and the understanding of the prognosis and future care of the kidney disease. Our findings highlighted participant confusion about the nature of conservative kidney management, which stems from an initial lack of clarity about how conservative kidney management differed from conventional treatments for chronic kidney disease stage 5. In particular, some respondents were not aware of the implicit palliative nature of the intervention or indeed the inevitable end-of-life issues. Although these findings can be situated within the context of communication failure, we would further argue that they also bring to the surface tensions in the discourses surrounding ageing and old age, drawing on the use of a \u2018natural\u2019 and a \u2018normal\u2019 paradigm of ageing. In the context of chronic kidney disease stage 5, more patients are being dialysed at older ages, but conservative kidney management is being advanced as a better option than dialysis in terms of quality of life and experience. However, in doing so, conservative kidney management implicitly draws on a notion of older age that echoes natural ageing rather than advocate a more interventionist approach. The role of discourses of ageing in the provision of treatments for conservative kidney management has not previously been acknowledged, and this article addresses this gap.<\/jats:p>","DOI":"10.1177\/1363459314524805","type":"journal-article","created":{"date-parts":[[2014,4,2]],"date-time":"2014-04-02T21:39:46Z","timestamp":1396474786000},"page":"613-630","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":20,"title":["The experiences of close persons caring for people with chronic kidney disease stage 5 on conservative kidney management: Contested discourses of ageing"],"prefix":"10.1177","volume":"18","author":[{"given":"Joe","family":"Low","sequence":"first","affiliation":[{"name":"University College London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason","family":"Myers","sequence":"additional","affiliation":[{"name":"University College London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Glenn","family":"Smith","sequence":"additional","affiliation":[{"name":"Imperial College London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Higgs","sequence":"additional","affiliation":[{"name":"University College London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aine","family":"Burns","sequence":"additional","affiliation":[{"name":"University College London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine","family":"Hopkins","sequence":"additional","affiliation":[{"name":"Royal Free Hampstead NHS Trust, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Louise","family":"Jones","sequence":"additional","affiliation":[{"name":"University College London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2014,4,1]]},"reference":[{"key":"bibr1-1363459314524805","doi-asserted-by":"publisher","DOI":"10.1191\/0269216305pm1043oa"},{"key":"bibr2-1363459314524805","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2007.01.017"},{"key":"bibr3-1363459314524805","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.00510109"},{"key":"bibr4-1363459314524805","first-page":"21","volume":"61","author":"Costa D","year":"2005","journal-title":"Genus"},{"key":"bibr5-1363459314524805","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfm772"},{"key":"bibr6-1363459314524805","doi-asserted-by":"publisher","DOI":"10.1017\/S0144686X08008271"},{"key":"bibr7-1363459314524805","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2010.07.022"},{"key":"bibr8-1363459314524805","volume-title":"Time of Our Lives: The Science of Human Ageing","author":"Kirkwood T","year":"1999"},{"key":"bibr9-1363459314524805","doi-asserted-by":"publisher","DOI":"10.1038\/sj.ki.5002343"},{"key":"bibr10-1363459314524805","first-page":"67","volume":"2","author":"Low J","year":"2008","journal-title":"NDT Plus"},{"key":"bibr11-1363459314524805","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1002\/9781118269640.ch16","volume-title":"Handbook of Gerontology: Evidence-Based Approaches to Theory, Practice, and Policy","author":"Montgomery RJV","year":"2007"},{"key":"bibr12-1363459314524805","doi-asserted-by":"crossref","unstructured":"Morton RL, Tong A, Howard K, (2010) The views of patients and carers in treatment decision making for chronic kidney disease: Systematic review and thematic synthesis of qualitative studies. BMJ 340: c12. Available at: http:\/\/www.bmj.com\/highwire\/filestream\/343695\/field_highwire_article_pdf\/0\/bmj.c112 (accessed 16 December 2013).","DOI":"10.1136\/bmj.c112"},{"key":"bibr13-1363459314524805","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2011.08.024"},{"key":"bibr14-1363459314524805","unstructured":"Murtagh FEM (2009) Understanding and improving quality of care for people with conservatively-managed stage 5 chronic kidney disease \u2013 The course of symptoms and other concerns over time. PhD Thesis, King\u2019s College London, London."},{"key":"bibr15-1363459314524805","doi-asserted-by":"publisher","DOI":"10.1093\/acprof:oso\/9780199560035.003.0015"},{"key":"bibr16-1363459314524805","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfm153"},{"key":"bibr17-1363459314524805","doi-asserted-by":"publisher","DOI":"10.1007\/s12376-009-0026-4"},{"key":"bibr18-1363459314524805","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2012.06.011"},{"key":"bibr19-1363459314524805","doi-asserted-by":"publisher","DOI":"10.1057\/biosoc.2011.10"},{"key":"bibr20-1363459314524805","doi-asserted-by":"publisher","DOI":"10.1159\/000073708"},{"key":"bibr21-1363459314524805","unstructured":"The National End of Life Care Programme (2008) End of life care in advanced kidney disease: A framework for implementation. 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