Research has revealed a new prediction model that estimates survival probabilities for patients with advanced chronic kidney disease (CKD) considering conservative care versus dialysis. This model, developed using data from the national Veterans Affairs and OptumLabs DataWarehouse databases, will be presented at the ASN Kidney Week 2025, scheduled for November 5–9, 2025.
Identifying which patients will benefit most from conservative management rather than dialysis can be difficult. The study highlights several factors that are associated with a higher mortality risk in veterans suffering from advanced CKD. These include older age, a more rapid decline in estimated glomerular filtration rate, elevated albuminuria levels, and worse frailty indexes. Additional risk factors encompass lower serum albumin and body mass index, recent hospitalizations, underlying heart disease, sepsis, tobacco use, and transitions to dialysis.
According to Connie Rhee, MD, MSc, the corresponding author and a researcher at the University of California Los Angeles and the Veterans Affairs Greater Los Angeles Healthcare System, “This new risk prediction tool was developed to estimate the individualized probability of survival with conservative non-dialytic management versus dialysis transition.” Rhee added that the model demonstrated moderate discrimination, effectively distinguishing between patients at higher and lower risk, as well as acceptable calibration performance in two national cohorts.
The study is part of the larger OPTIMAL initiative, which aims to establish a more robust evidence base for conservative non-dialytic management in patients with advanced CKD. Rhee emphasized the importance of this research, stating, “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.”
As the healthcare landscape continues to evolve, the development of tools like this prediction model can significantly enhance the shared decision-making process between patients, care partners, and healthcare providers. The goal is to support discussions surrounding treatment options, ensuring that patients receive care tailored to their individual needs and circumstances.
The introduction of this predictive model represents a step forward in the management of advanced CKD, fostering a deeper understanding of how different care strategies can impact patient outcomes. As research in this area progresses, it is hoped that more effective, patient-centered approaches to treatment will emerge, ultimately improving quality of life for those affected by chronic kidney disease.
