Kidney Week

Abstract: FR-PO005

Shared Decision-Making and Enhancement of Patient Autonomy in the Selection of Kidney Replacement Therapy: A Retrospective Study at a Single Center, Seoul National University Bundang Hospital

Session Information

• Classroom to Bedside: Transforming Medical Education
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Educational Research

• 1000 Educational Research

Authors

• You, Julee, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)

Julee You, MD

• Kwon, Eun-Jeong, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)

Eun-Jeong Kwon, MD

• Chin, Ho Jun, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)

Ho Jun Chin, MD, PhD

• Kim, Sejoong, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)

Sejoong Kim, MD, PhD

• Park, Seokwoo, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)

Seokwoo Park, MD

Background

In patients with CKD approaching end-stage kidney disease(ESKD), effective shared decision-making(SDM) plays a crucial role in selecting the most suitable renal replacement therapy(RRT). We examined the impact of the SDM program on the preference for kidney transplantation or peritoneal dialysis(KT/PD) over hemodialysis(HD), and its potential to reduce unplanned dialysis.

Methods

The SDM program commenced at Seoul National University Bundang Hospital, South Korea, in March 2021, as part of the SDM-ART trial. Adult patients predicted to reach ESKD within a year, were enrolled in the SDM. Participants received extensive education using materials and videos, followed by in-depth discussions with physicians based on self-assessment items at months 0 and 2, in contrast to standard brief consultations. Data were collected in a single center from CKD patients with an eGFR of less than 15 ml/min/1.73m² over 3 months, during March 2018 to March 2023, excluding those with contraindication for PD. Logistic regressions were used to compare the likelihood of selecting KT/PD over HD and the occurrence of unplanned dialysis before and after the SDM program. Physicians were categorized based on their involvement in the SDM, and the interaction between SDM implementation and physicians' participation was analyzed.

Results

Among 556 patients starting RRT, 34.0% chose KT/PD, while 41.7% underwent unplanned HD with central venous catheters before long-term RRT. Before SDM, there was no significant difference in the preference for KT/PD vs HD between physicians who participated in SDM and those who did not. However, post-SDM, patients under SDM-participating physicians significantly favored KT/PD (OR, 4.24; 95% CI, 1.29-14.50), unlike those under non-participating physicians(Table 1). SDM could not significantly reduce unplanned dialysis in this cohort.

Conclusion

Our SDM program demonstrated a significant shift in the preference for RRT modality towards KT/PD, highlighting the critical importance of overcoming informational barriers.