A new prediction model has been developed to help determine whether patients with advanced chronic kidney disease (CKD) will benefit more from conservative care or dialysis. Researchers utilized data from the national Veterans Affairs and OptumLabs DataWarehouse to create this model, which estimates individualized survival probabilities. The findings will be presented at the upcoming ASN Kidney Week 2025 scheduled for November 5–9.
The study specifically evaluated veterans with advanced CKD, comparing outcomes between those who underwent dialysis and those who received non-dialytic management. Key factors linked to a higher risk of mortality included older age, a more rapid decline in estimated glomerular filtration rate, elevated albuminuria levels, and various health conditions such as heart disease and sepsis.
Dr. Connie Rhee, the corresponding author and a researcher at the University of California Los Angeles and the Veterans Affairs Greater Los Angeles Healthcare System, emphasized the significance of this tool. “This new risk prediction tool was developed to estimate the individualized probability of survival with conservative non-dialytic management versus dialysis transition,” she noted. The model demonstrated moderate discrimination and acceptable calibration performance when tested across two national cohorts of patients with advanced CKD.
The research is part of the larger study titled “Defining Optimal Transitions of Care in Advanced Kidney Disease: Conservative Management vs. Dialysis Approaches (OPTIMAL).” The objective of the OPTIMAL study is to create a stronger evidence base for non-dialytic management of advanced CKD patients.
Dr. Rhee highlighted that the rigorous examination of conservative management against dialysis transition could significantly impact treatment options available to patients. “Our findings, along with others in this field, have the potential to expand viable, patient-centric treatment options for CKD,” she stated.
The team aims for this model, along with other methodologies, to facilitate shared decision-making among patients, their care partners, and healthcare providers regarding the best management approach for advanced CKD. By providing a clearer understanding of individual risks, the model could play a crucial role in guiding patients toward the most suitable care pathway.
