A new prediction model aims to clarify whether patients with advanced chronic kidney disease (CKD) benefit more from conservative care or dialysis. Developed and validated using data from the national Veterans Affairs and OptumLabs DataWarehouse databases, this tool estimates individualized survival probabilities. The research will be presented at the ASN Kidney Week 2025, scheduled for November 5–9, 2025.
Key findings reveal specific factors that correlate with higher mortality risks among veterans receiving either dialytic or non-dialytic management. These include older age, a significant decline in estimated glomerular filtration rate, elevated levels of albuminuria, and various health conditions such as heart disease and recent hospitalization. Notably, patients with lower serum albumin levels and lower body mass index were also found to be at greater risk.
Dr. Connie Rhee, MD, MSc, from the University of California Los Angeles and the Veterans Affairs Greater Los Angeles Healthcare System, emphasized the importance of this new tool. “This new risk prediction tool was developed to estimate the individualized probability of survival with conservative non-dialytic management versus dialysis transition,” she stated. The model demonstrated moderate discrimination in identifying higher risk patients and acceptable calibration performance when compared to actual mortality probabilities.
The research is part of the broader Defining Optimal Transitions of Care in Advanced Kidney Disease: Conservative Management vs. Dialysis Approaches (OPTIMAL) study. This initiative seeks to build a robust evidence base for conservative management in patients with advanced CKD.
Dr. Rhee continued, “By rigorously studying the comparative effectiveness of conservative management versus dialysis transition, findings from our and others’ research have the potential to expand viable, patient-centric treatment options for CKD.” The goal is to provide tools that enhance shared decision-making among patients, their care partners, and healthcare providers regarding the best approach to managing their condition.
This development highlights an ongoing need for personalized treatment strategies in the field of nephrology. As the medical community continues to explore effective management options, the insights gained from this research may lead to improved outcomes for patients facing the complexities of advanced CKD.
