Conservative kidney management (CKM) is a patient-centered package of services for patients with kidney failure who are unlikely to receive a survival and/or quality-of-life (QoL) advantage with dialysis. It rests on shared decision making, involves interventions to delay the progression of kidney failure and minimize complications (including symptom management), and incorporates advance care planning and psychosocial and family support.1 However, it does not include dialysis. The provision of CKM in the United States lags much of the international nephrology community, including Canada, Australia, New Zealand, and many European countries.