In a significant development for patients with advanced chronic kidney disease (CKD), researchers have unveiled a prediction model designed to identify which individuals may benefit more from conservative care rather than initiating dialysis. This model, developed using data from the national Veterans Affairs and OptumLabs® DataWarehouse databases, will be presented at the American Society of Nephrology’s (ASN) Kidney Week 2025, scheduled for November 5–9.
The study, which focuses on veterans with advanced CKD, highlights that certain factors correlate with a higher risk of mortality when comparing dialytic versus non-dialytic management. These factors include older age, a higher baseline and more rapid decline in estimated glomerular filtration rate, increased albuminuria levels, worse frailty indices, lower serum albumin, and lower body mass index. Additionally, recent hospitalization, underlying heart disease, sepsis, tobacco use, and the transition to dialysis were noted as significant risk contributors.
Understanding the Prediction Model
The model aims to provide an individualized estimate of survival probabilities for patients opting for conservative non-dialytic management versus those transitioning to dialysis. According to Dr. Connie Rhee, the corresponding author from the University of California Los Angeles and the Veterans Affairs Greater Los Angeles Healthcare System, the tool demonstrates moderate discrimination and acceptable calibration performance. This means it can effectively differentiate between patients at higher versus lower mortality risk and aligns well with actual observed outcomes.
“This new risk prediction tool was developed to estimate the individualized probability of survival with conservative non-dialytic management versus dialysis transition,” said Dr. Connie Rhee. “Our objective is to establish a stronger evidence base for conservative non-dialytic management in the advanced CKD population.”
Implications for CKD Treatment
The introduction of this model is part of the broader National Institutes of Health-funded study titled ‘Defining Optimal Transitions of Care in Advanced Kidney Disease: Conservative Management vs. Dialysis Approaches (OPTIMAL).’ The study seeks to expand viable, patient-centric treatment options for CKD by rigorously comparing the effectiveness of conservative management against dialysis transition.
Dr. Rhee emphasizes the potential of this research to enhance shared decision-making among patients, care partners, and healthcare providers. By offering a robust tool for evaluating treatment options, the study aims to support informed choices that align with patient preferences and clinical realities.
The Broader Context
The announcement comes as the medical community increasingly recognizes the need for personalized treatment approaches in chronic diseases. Historically, CKD treatment has heavily relied on dialysis as a primary intervention. However, recent studies suggest that conservative management can be a viable alternative for certain patient populations, potentially improving quality of life and reducing healthcare costs.
Experts in nephrology are keenly watching the outcomes of the OPTIMAL study, as its findings could reshape standard care practices. The model’s validation in two national cohorts underscores its potential applicability across diverse patient groups, offering a new dimension to CKD management strategies.
Looking Ahead to Kidney Week 2025
ASN Kidney Week 2025 in Houston, TX, promises to be a pivotal event for nephrology professionals worldwide. With approximately 12,000 participants expected, the meeting will provide a platform for exchanging knowledge, learning about the latest scientific and medical advances, and engaging in discussions with leading experts in the field. Early programs begin on November 5, followed by the Annual Meeting from November 6-9.
As the world’s premier nephrology meeting, Kidney Week offers exciting opportunities for professionals to explore innovative research and clinical practices. The conversation will continue online under the hashtag #KidneyWk, fostering a global dialogue on the future of kidney care.
The development of this prediction model represents a significant step forward in personalized medicine for CKD patients, offering hope for more tailored and effective treatment pathways. As the medical community gathers at Kidney Week 2025, the implications of this research will undoubtedly be a focal point of discussion, potentially guiding future standards in CKD management.
