Determining which patients with advanced chronic kidney disease (CKD) would benefit more from conservative therapy rather than dialysis remains a clinical challenge. To address these problems, researchers have validated and developed a new prediction model that estimates individualized survival probabilities for advanced CKD patients. Data for this study were collected from the OptumLabs® data warehouse and the national Veterans Affairs databases.
In this study, researchers compared outcomes between patients managed conservatively and those who initiated dialysis, identifying several factors associated with higher mortality risk. These patients included older age, increased albuminuria, higher baseline, declining estimated glomerular filtration rate (eGFR), lower serum albumin levels, recent hospitalization, greater frailty, and lower body mass index (BMI), as well as comorbid conditions like sepsis, tobacco use, and heart disease. Patients who transitioned to dialysis also reported an increased risk of mortality.
This study was funded by the National Institutes of Health (NIH). The project titled Optimal Transitions of Care in Advanced CKD: Conservative vs Dialysis Approaches (OPTIMAL) aims to improve understanding of care transitions for patients with advanced CKD. The initiative aims to strengthen the evidence base for conservative management in advanced CKD, an area with historically limited data.
Dr. Connie Rhee, author, University of California, Los Angeles, and the Veterans Affairs Greater Los Angeles healthcare system, said that the new risk prediction model reported a moderate discrimination and the ability to accurately distinguish between lower- and higher risk patients, as well as acceptable calibration measurements during two cohorts of advanced CKD patients. This model was established to provide personalized survival estimates for patients considering non-dialysis versus dialysis management. This tool predicted mortality probabilities aligned closely with observed outcomes.
Dr. Rhee also added that “our goal is to enhance patient autonomy as well as to support clinicians in guiding treatment decisions that align with health goals and patients’ values. It represents a step forward supporting individualized and evidence-based decision-making in advanced CKD healthcare.”
This research study was presented in the session titled “development and validation of mortality prediction model for conservative therapy versus dialysis in advanced CKD: analysis of two national cohorts” at ASN Kidney Week 2025, held November 5-9 in Houston, Texas. This study compares the effectiveness of conservative care with dialysis treatment. The researchers seek to identify patient-centered treatment options. The goal of this study is to develop tools and strategies that increase shared decision-making among healthcare providers, caregivers, and patients regarding whether to initiate the dialysis process or conservative management. This study ultimately improved the quality of life and personalized care for patients with advanced CKD.
Reference: Christine Feheley. Conservative Care Versus Dialysis: Model Indicates Which Is Best for Individual Patients with Advanced Chronic Kidney Disease. American Society of Nephrology (ASN). Published November 13, 2025. Accessed November 13, 2025. Conservative Care Versus Dialysis: Model Indicates Which Is Best for Individual Patients with Advanced Chronic Kidney Disease
