Model shows which is better for individual advanced chronic kidney disease patients

It can be challenging to identify which patients with advanced chronic kidney disease (CKD) will most benefit from conservative care rather than initiating dialysis.

Researchers have recently developed and validated a prediction model to estimate individualized survival probabilities with conservative non-dialytic management versus dialysis in patients with advanced CKD from the national Veterans Affairs and OptumLabs DataWarehouse databases. The work will be presented at ASN Kidney Week 2025 from November 5–9.

Investigators found that among veterans with advanced CKD who received dialytic versus non-dialytic management, certain factors were linked to higher mortality risk, including older age; higher baseline and more rapid decline in estimated glomerular filtration rate; higher albuminuria levels; worse frailty indexes; lower serum albumin and lower body mass index; recent hospitalization; underlying heart disease, sepsis, or tobacco use; and dialysis transition.

“This new risk prediction tool was developed to estimate the individualized probability of survival with conservative non-dialytic management versus dialysis transition, which demonstrated moderate discrimination (the ability to accurately differentiate between those at higher versus lower risk) and acceptable calibration performance (the degree of agreement between the predicted mortality risk probability and the actual observed probability of death) in two national cohorts of patients with advanced CKD,” said corresponding author Connie Rhee, MD, MSc, of the University of California Los Angeles and the Veterans Affairs Greater Los Angeles Healthcare System.

“This study was conducted as part of the ‘Defining Optimal Transitions of Care in Advanced Kidney Disease: Conservative Management vs. Dialysis Approaches (OPTIMAL)’ study, in which our objective is to establish a stronger evidence base for conservative non-dialytic management in the advanced CKD population.

“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. We aim 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.”