# Defining Optimal Transitions of Care in Advanced Kidney Disease: Conservative Management vs. Dialysis Approaches

> **NIH NIH R01** · UNIVERSITY OF CALIFORNIA-IRVINE · 2020 · $668,355

## Abstract

PROJECT SUMMARY/ABSTRACT
 The 1972 Medicare End-Stage Renal Disease (ESRD) program has led to near-universal access to dialysis
in order to extend the survival of advanced chronic kidney disease (CKD) patients progressing to ESRD. Each
year ~120,000 patients in the US transition to dialysis as the dominant yet costly treatment paradigm for
uremic, biochemical, and volume derangements. However, in the past 4½ decades, there has been little
progress or innovation in developing patient-centered treatment options for advanced CKD beyond dialysis.
Pioneering research led by our team under the NIH U01 “Transitions of Care in CKD” (TCCKD) United States
Renal Data System (USRDS) Special Study Center have shown that transition to dialysis is associated with 1)
high mortality particularly in the 1st year of treatment, 2) frequent hospitalizations, 3) poor health-related quality
of life (HRQOL), 4) loss of independence, 5) functional decline, and 6) high withdrawal dates, particularly in
elderly and comorbid patients. This has prompted rising interest and pressing urgency for conservative
dialysis-free management as an alternative treatment option. Yet this strategy remains under-utilized due to
major uncertainties regarding 1) the comparative effectiveness of conservative management vs. dialysis on
hard outcomes and patient-centered endpoints, and 2) which patients will benefit from dialysis-free treatment.
 Our Multiple-PI R01 proposal will address these knowledge gaps by using innovative longitudinal data
sources from two of the largest US integrated healthcare systems, namely OptumLabs (United Healthcare) and
national Veterans Affairs (VA) data linked to Medicare and USRDS resources (2007-18), paired with a well-
defined prospective CKD cohort in the largest study of conservative management vs. dialysis transition to date.
Using propensity score matching, Aim 1 will examine associations of conservative management vs. dialysis
transition with mortality and hospitalization (co-primary outcomes), and skilled nursing facility placement,
intensive care admissions, and healthcare costs (secondary outcomes) in two large OptumLabs and VA
cohorts each with >0.5 million advanced CKD (eGFR <25ml/min/1.73m2) patients. In these two cohorts, Aim 2
will develop clinical prognostic models that predict an individual’s likelihood of survival and hospitalization with
conservative management vs. dialysis. In a prospective cohort of 116 stage 4-5 CKD patients, Aim 3 will
compare the impact of conservative management vs. dialysis preparation on the longitudinal trajectory of
HRQOL (primary outcome) and physical performance/activity, symptoms, and nutrition (secondary outcomes)
using rigorous protocolized data collection with validated instruments. Our findings will have substantial impact
on patient care and policy by 1) expanding patient-centered treatment options for the vast CKD population, 2)
generating rigorous evidence for clinical guidelines by identifying which patie...

## Key facts

- **NIH application ID:** 10143676
- **Project number:** 1R01DK124138-01A1
- **Recipient organization:** UNIVERSITY OF CALIFORNIA-IRVINE
- **Principal Investigator:** Kamyar Kalantar-Zadeh
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $668,355
- **Award type:** 1
- **Project period:** 2020-09-15 → 2025-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10143676

## Citation

> US National Institutes of Health, RePORTER application 10143676, Defining Optimal Transitions of Care in Advanced Kidney Disease: Conservative Management vs. Dialysis Approaches (1R01DK124138-01A1). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10143676. Licensed CC0.

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