Conservative Management Versus Dialysis for Patients With Advanced CKD

Although the prevailing treatment paradigm for patients with advanced chronic kidney disease (CKD) progressing to end-stage kidney disease is dialysis, there is increasing interest in conservative management (CM). In certain subgroups of patients with advanced CKD, CM offers an alternative, patient-centered treatment strategy.

Researchers conducted an analysis among a cohort of US veterans with advanced CKD to compare the impact of CM on the risk of cognitive dysfunction with that of transition to dialysis. Results were reported at the National Kidney Foundation Spring Clinical Meetings 2025.

The analysis included linked national data from the Veterans Association, United States Renal Data System, and Medicare. Advanced CKD was defined as having 2 or more estimated glomerular filtration rates (eGFRs) of 25 mL/min/1.73 m² or less separated by 90 days or more. Patients with advanced CKD were identified as not receiving dialysis within 2 years of the index eGFR (CM) or receiving dialysis within 2 years of the index eGFR. Using unadjusted and doubly adjusted Cox models, the researchers compared the risk of incident dementia, mild cognitive impairment (MCI), and dementia or MCI (combined dementia/MCI) in the 2 groups.

A total of 90,017 patients met the eligibility criteria. Of those, 15,844 developed dementia, 3,406 developed MCI, and 16,858 developed dementia or MCI. In unadjusted models, there was an association between transition to dialysis and higher risk of incident dementia (hazard ratio [HR], 1.40; 95% CI, 1.31-1.49), MCI (HR, 1.39; 95% CI, 1.23-1.58), or combined dementia/MCI (HR, 1.26; 95% CI, 1.28-1.44) compared with CM. Results were similar in sensitivity analyses doubly adjusted for propensity score covariates.

“In a national cohort of veterans, transition to dialysis was associated with higher risk of dementia and MCI versus CM,” the researchers said. “Further studies are needed to determine the mechanistic pathways underlying the differential risk of cognitive dysfunction across advanced CKD treatment strategies.”

Source: Narasaki Y, Kalantar-Zadeh K, Siu M, et al. Impact of conservative management vs. dialysis on cognitive dysfunction in US veterans with advanced CKD. Abstract #G-405. Presented at the National Kidney Foundation Spring Clinical Meetings 2025; April 10-13, 2025; Boston, MA. doi:10.1053/j.ajkd.2025.02.406