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A shared decision-making intervention resulted in a significantly lower incidence of unplanned dialysis versus usual care in advanced chronic kidney disease.

Previous research has shown that shared decision-making (SDM) improves patient satisfaction regarding dialysis modality decisions. In addition, SDM is associated with better patient survival. Although SDM is recommended for guiding the selection of a renal replacement therapy modality, there remains a significant lack of data on its effectiveness in reducing unplanned dialysis.

For a retrospective cohort study published in BMC Nephrology, researchers evaluated the effectiveness of SDM in decreasing unplanned dialysis compared with physician-directed decision-making among patients with advanced-stage chronic kidney disease (CKD). They also examined predictive factors related to unplanned dialysis in this patient population. Unplanned dialysis was defined as dialysis initiated through a temporary catheter or within in a short period after the initial dialysis decision was made.

The primary end point was the percentage of patients who began undergoing unplanned dialysis.

The study included 116 patients aged 18 years and older with CKD stages 4 and 5 who were receiving renal replacement therapy. Of the cohort, 66 received the SDM intervention and 44 received usual care. Comorbidities identified in both groups included diabetes, cardiovascular disease, and cancer. Although not statistically significant, the researchers noted that patients receiving the SDM intervention exhibited a lower median BMI (23.09 vs 25.22) and were more likely to receive peritoneal dialysis (27.27% vs 13.33%).

Efficacy of SDM Intervention in Reducing Unplanned Dialysis

Incidence of unplanned dialysis was significantly lower in the SDM arm versus the standard care arm (33.3% vs 66.7%; P<0.001). After adjusting for potential compounding factors, researchers found that the risk for unplanned dialysis was considerably lower in the SDM group versus the usual care group (adjusted odds ratio [OR], 0.19; 95% CI, 0.07-0.47; P=0.001).

In the multivariate analysis, factors serving to protect against unplanned dialysis included participation in the SDM program (OR, 0.19; P=0.001), peritoneal dialysis (OR, 0.26; P=0.032), and higher serum albumin level at the initiation of dialysis (OR, 0.33; P=0.014).

The researchers found that SDM is an effective intervention for reducing the incidence of unplanned dialysis, underscoring the importance of the SDM program in enhancing care and outcomes for patients with advanced-stage CKD.

“Future prospective cohort studies are necessary to evaluate the efficacy, feasibility, cost-effectiveness, and other important clinical outcomes … of SDM programs in a larger population of advanced CKD patients to confirm their role as a viable intervention,” the authors wrote.