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Helping individuals through shared decision making led to prior dialysis planning, good treatment alignment, and improved outcomes shaped by age, frailty, and support systems. 

Researchers conducted a retrospective study published in the June 2025 issue of BMC Nephrology to evaluate dialysis modality selection and clinical outcomes among patients with kidney failure (KF) following a shared decision-making (SDM) intervention.  

They assessed 484 patients with KF from 1 regional and 1 university hospital between 2018 and 2023. The exposure variable was a SDM intervention for dialysis modality. Predictors included frailty, estimated glomerular filtration rate (eGFR), comorbidities, Body Mass Index (BMI), ethnicity, marital status, and smoking status. Primary outcomes were selection of home-based dialysis, time to initiation, treatment concordance, and pre-treatment mortality. Fisher’s exact and Wilcoxon rank-sum tests investigated differences in dialysis modality choice. Aalen-Johansen estimations assessed the time to initiation, concordance between chosen and initiated modality, and mortality before treatment. Logistic regression and Cox proportional hazards models identified predictors associated with these outcomes.  

The results showed that 68% of patients selected home-based dialysis and 32% opted for center-based dialysis after the SDM intervention. Home-based dialysis was significantly more common among patients aged ≤70 years, those treated at the university hospital, and those living with a partner. Dialysis was initiated within 11 months in 50% of cases, while delayed initiation beyond 11 months was associated with age ≥70 years and eGFR) = >15 ml/min/1.73 m². Concordance between selected and initiated treatment occurred in 83% of patients, with predictors including center-based dialysis, treatment at the regional hospital, and frailty classified as very mild to mild. A total of 12% of patients died before dialysis initiation, with predictors being frailty from very mild to severe and BMI<25 kg/m².  

Investigators concluded that most patients opted for and initiated home-based dialysis following the intervention, and that early assessment of frailty and BMI may have supported improved treatment planning. 

Source: bmcnephrol.biomedcentral.com/articles/10.1186/s12882-025-04220-1