Photo Credit: AlexLMX

Shared decision making helped nearly 70% of patients with kidney failure choose home dialysis, with high concordance between selected and initiated treatment.

“Shared decision making (SDM) plays a central role in managing kidney failure (KF) in many nephrology [centers],” researchers wrote in BMC Nephrology. “The progressive nature of KF underscores the need for continuous collaboration between patients and healthcare professionals, allowing personalized treatment choices as kidney function declines. SDM enables patients with KF to actively participate in selecting their dialysis modality, either [hemodialysis] or peritoneal dialysis.”

The study team conducted a retrospective study to evaluate dialysis modality selection and clinical outcomes among patients with KF following an SDM intervention.

They assessed 484 patients with KF from one regional and one university hospital between 2018 and 2023. The exposure variable was a SDM intervention for dialysis modality, and predictors included frailty, estimated glomerular filtration rate (eGFR), comorbidities, BMI, ethnicity, marital status, and smoking status.

Primary outcomes that were assessed included selection of home-based dialysis, time to initiation, treatment concordance, and pre-treatment mortality. The researchers used Fisher’s exact and Wilcoxon rank-sum tests to examine differences in dialysis modality choice, and 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.

Dialysis Selection & Related Factors

Baseline characteristics between the groups who chose home-based dialysis versus-center based dialysis were similar. Median age was between 69 and 70 years, and more than 60% of patients in each group were men. Less than a quarter of patients in each group were denoted as smokers.

More patients (68%) selected home-based dialysis compared with center-based dialysis (32%) after the SDM intervention. Home-based dialysis was significantly more common among patients aged 70 years and younger, those treated at the university hospital, and those living with a partner. Dialysis was initiated within 11 months in 50% of cases, and 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; predictors of this outcome included frailty ranging from very mild to severe and a BMI of less than 25 kg/m².

“This study is the first to describe the pathway of patients with KF after an SDM-DC intervention,” the researchers wrote. “Frailty and nutritional status are important predictors for the observed outcomes, which could be used in clinical practice to improve these outcomes.”