Chronic kidney disease (CKD) is defined as impaired kidney function and proteinuria present over at least 3 months and is often present along with cardiovascular disease and diabetes. Estimated glomerular filtration rate (eGFR) of <60mL/min/1.73m is considered as a measure of impaired kidney function, which along with presence of albuminuria, abnormal histological findings (as detected through kidney tissue biopsy) or urine sediment abnormalities are used to diagnose CKD. Based on eGFR values, CKD is classified into 5 stages. Among them CKD stage 4 (eGFR 15-29 mL/min/1.73m) indicates severe loss of kidney function and CKD stage 5 (eGFR < 15 mL/min/1.73m) indicates kidney failure also called end stage renal disease (ESRD). Earlier stages (stages 1, 2 and 3) can be asymptomatic and may be reversible with medical management. CKD is a major public health concern globally and in Canada affecting 12.5% or roughly 3 million Canadians during the period 2007-2009. Increasing prevalence of CKD has been attributed to a growing elderly population and increasing rates of diabetes, hypertension and other cardiovascular risk factors. When the kidney fails, treatment options are contained to a) Renal replacement therapy by way of hemodialysis (HD), peritoneal dialysis (PD) or renal transplantation or b) conservative management (CM). CKD management is a significant burden on the healthcare system and is associated with high cost. The costs associated with treating ESRD alone accounts for around 1.1% of annual health spending in Canada. Annual cost per year per patient on HD or PD is just under $10,000 CAD. Dialysis is also associated with several other disadvantages such as need for vascular access, risk of complications, access to resources (for e.g., equipment, center space), interruptions to daily life and decline of functional status, all of which could be a higher burden for elderly patients with other major comorbidities. CM has been proposed as a comprehensive non-dialysis care to prolong kidney function, management of symptoms, acidosis, anemia, bone and mineral metabolism, blood pressure, and dietary support. It involves individualizing care through shared decision making to offer psychological, social and spiritual support for the patients. Although dialysis care has been shown to prolong life expectancy, factors such as quality of life, hospital free survival and general wellbeing of the patients are of paramount importance and need to be actively managed. A shared decision making process will enable the patient, caregiver and the healthcare provider to ensure that patient preferences, goals and medical concerns have been sufficiently addressed while deciding conservative or dialysis care is the best option for the patient. Economic considerations also play an important role from this decision making process from a healthcare provider perspective. The purpose of this report is to summarize the evidence regarding clinical effectiveness and cost effectiveness of CM in patients with late or end stage CKD (CKD4/5 ESRD).