Recent advancements in the management of advanced chronic kidney disease (CKD) have led to the development of a new prediction model that assists healthcare providers in deciding between conservative care and dialysis for individual patients. This research, which utilizes data from the national Veterans Affairs and OptumLabs DataWarehouse databases, will be presented at the upcoming ASN Kidney Week 2025, scheduled for November 5–9, 2025.
The prediction model aims to estimate individualized survival probabilities for patients with advanced CKD considering non-dialytic management versus transitioning to dialysis. Key findings indicate that various factors significantly correlate with higher mortality risks among veterans receiving either treatment. These factors include older age, a higher baseline and more rapid decline in estimated glomerular filtration rate, elevated levels of albuminuria, and poorer frailty indexes. Additionally, lower serum albumin levels, reduced body mass index, recent hospitalizations, and underlying health conditions such as heart disease and sepsis were also noted as contributing factors.
Dr. Connie Rhee, MD, MSc, a leading researcher from the University of California Los Angeles and the Veterans Affairs Greater Los Angeles Healthcare System, emphasized the significance 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. “It demonstrated moderate discrimination and acceptable calibration performance in two national cohorts of patients with advanced CKD.”
The study is part of the larger initiative, Defining Optimal Transitions of Care in Advanced Kidney Disease: Conservative Management vs. Dialysis Approaches (OPTIMAL). The objective of this initiative is to strengthen the evidence base for conservative non-dialytic management in patients with advanced CKD. By comparing the effectiveness of conservative management against dialysis, researchers hope to expand treatment options that prioritize patient-centered care.
Dr. Rhee added, “Our aim is for this tool and other approaches to support and enhance the shared decision-making process regarding conservative management versus dialysis initiation among patients, care partners, and health care providers.”
As healthcare systems continue to evolve, tools like this prediction model are crucial in guiding treatment decisions tailored to the individual needs of patients with advanced CKD.
