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Figure 2. The MRC framework for the evaluation of complex interventions Conservative care management delivery and availability varies worldwide and even variations exist within the same nation. Phase II and III RCT as defined by MRC can be performed in areas without established care. A pragmatic approach such as cluster randomization and stepped wedge design may be the way forward. In established areas where this management is already being performed, a Phase IV can be embarked upon choosing specific outcomes and looking to refine the care. Care packages can be standardized and adopted nationwide with research involving multi-centers. A mixed method design, incorporating an addition of qualitative component will be an added value to trial designs and will give richness and depth of data. Other study designs such as cross-sectional, cohort, routine data can be performed but there are many limitations. Table 1. Types of Experimental Trial Conclusions: Research in examining effectiveness of conservative care management for ESRD patients need to move towards outcome measurements addressing the essentials of holistic components of Palliative Care. RCTs in clinical evaluation of effectiveness; taking the pragmatic approach, is the way forward. There is increasing value of adding qualitative components, mixed method designs. Other design trials, however, are subject to many limitations, making interpretation of results and its applicability to clinical practice difficult.

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months of hospital discharge had a higher increase in serum creatinine post discharge compared to pre-hospital admission (48 vs 6.5, p=0.003). Conclusions: Our pilot study demonstrates increased mortality in patients admitted with an AECOPD with a higher increase in serum creatinine, which is statistically significant. Further research, in the form of a prospective study, is required to determine an association with acute kidney injury in this patient population group which may highlight to physicians the importance of managing an acute kidney injury and helping prognosticate these patients for the future.