A major question in caring for people with advanced chronic kidney disease is not simply whether dialysis can extend life, but how treatment affects the life a patient is able to live. New research published in the July 2026 issue of Mayo Clinic Proceedings brings that question into sharper focus—and highlights the contributions of Kamyar Kalantar-Zadeh, MD, MPH, PhD, an investigator in the Translational Science and Population Health Innovation Hub at The Lundquist Institute and the study’s senior author.
The study, “Nondialytic Care vs Dialysis Transition on Hospitalization: Outcomes in Veterans With Advanced Chronic Kidney Disease,” examined a national cohort of U.S. Veterans with advanced kidney disease. Researchers compared patients who transitioned to dialysis with patients who did not begin dialysis during the study’s defined follow-up period. The research was conducted within the NIH-funded OPTIMAL study of advanced kidney disease care.
After carefully matching 13,020 patients in each group to make the comparison as fair as possible, the researchers found a striking pattern. Veterans who transitioned to dialysis had a 64 percent higher rate of hospitalization and a 71 percent higher rate of days spent in the hospital than those receiving nondialytic care. Hospital stays were also slightly longer on average. Importantly, the study found that earlier transitions to dialysis were linked with progressively higher hospitalization rates.
These findings do not mean that dialysis is the wrong choice. Dialysis is a lifesaving treatment for many people, and this study does not prove that dialysis, specifically, is the cause for increased hospital use. Instead, what this research shows is that the decision to begin dialysis is more complex than a single laboratory number or a one-size-fits-all treatment pathway.
That is what makes this work so important.
For people with advanced kidney disease, time spent in hospitals can have enormous consequences. Hospitalization can mean time away from family, disruptions to daily life, greater physical stress, and additional medical procedures. By measuring not only disease outcomes but also the burden of treatment, this research helps broaden the conversation about what successful kidney care should look like.
Dr. Kalantar-Zadeh’s role is especially meaningful given his longstanding work in chronic kidney disease, dialysis, population health, health disparities, and quality of life. His research at The Lundquist Institute reflects a sustained commitment to understanding kidney disease in real-world populations and identifying approaches that can help clinicians better tailor care to individual patients.
The study, collaboratively authored by field experts including Connie M. Rhee, MD, from UCLA Health and Veteran’s Affairs (VA) Greater Los Angeles Healthcare System, also demonstrates the value of veteran’s health data in answering questions that can influence care far beyond the VA system. By studying a large, real-world patient population, the research provides evidence that can help clinicians and families have more informed conversations about when dialysis should begin, when a nondialytic approach may be appropriate, and which outcomes matter most to the patient.
Ultimately, this research advances a more human-centered view of kidney care: treatment decisions should consider not only how medicine can prolong life, but how it can protect quality of life. That perspective has the potential to improve care for veterans and people living with chronic kidney disease everywhere.
To read the publication, visit https://pubmed.ncbi.nlm.nih.gov/42246911/.