A new predictive model aims to optimize treatment decisions for patients with advanced chronic kidney disease (CKD) by assessing the benefits of conservative care versus dialysis. This model, developed using data from the national Veterans Affairs and OptumLabs DataWarehouse databases, estimates individualized survival probabilities for patients receiving non-dialytic management compared to those beginning dialysis. The findings will be presented at the ASN Kidney Week 2025, scheduled for November 5–9, 2025.
The research evaluated various factors linked to mortality risk among veterans with advanced CKD. Key indicators of increased risk included older age, a higher baseline and more rapid decline in estimated glomerular filtration rate, elevated albuminuria levels, and poorer frailty indexes. Additional risk factors comprised lower serum albumin, lower body mass index, recent hospitalizations, and underlying health conditions such as heart disease, sepsis, or tobacco use.
Corresponding author Connie Rhee, MD, MSc, from the University of California Los Angeles and the Veterans Affairs Greater Los Angeles Healthcare System, emphasized the significance of this new risk prediction tool. “This 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 broader OPTIMAL study, which focuses on defining optimal transitions of care in advanced kidney disease. The goal is to create a stronger evidence base for conservative non-dialytic management among patients with advanced CKD. Rhee noted, “By rigorously studying the comparative effectiveness of conservative management versus dialysis transition, our findings and those of others can expand viable, patient-centric treatment options for CKD.”
The development of this model is particularly relevant in the context of shared decision-making between patients, healthcare providers, and care partners. Rhee aims for the tool to enhance discussions around treatment options, ultimately supporting patients in their care choices. The ongoing research highlights a growing recognition of the importance of personalized treatment strategies in managing advanced kidney disease.
As healthcare continues to evolve, the insights gained from this study could significantly impact how clinicians approach treatment for advanced CKD, potentially leading to better patient outcomes and quality of life.
