Kidney Week

Abstract: SA-PO1136

Factors Associated with Decision Change through Shared Decision-Making Process Regarding Kidney Replacement Therapy

Session Information

• CKD: Patient-Oriented Care and Case Reports
  October 26, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Kitamura, Shunsuke, Department of Nephrology, Nara Prefectural General Medical Center, Nara, Japan

Shunsuke Kitamura, MD

• Matsui, Masaru, Department of Nephrology, Nara Medical University, Nara, Japan

Masaru Matsui, MD, PhD

• Yamamoto, Marumi, Department of Nephrology, Nara Prefectural General Medical Center, Nara, Japan

Marumi Yamamoto, MD

• Tansho, Kosuke, Department of Nephrology, Nara Prefectural General Medical Center, Nara, Japan

Kosuke Tansho

• Tsushima, Hideo, Department of Nephrology, Nara Prefectural General Medical Center, Nara, Japan

Hideo Tsushima, MD

• Tsuruya, Kazuhiko, Department of Nephrology, Nara Medical University, Nara, Japan

Kazuhiko Tsuruya, MD, PhD

Background

In Japan, 97% of patients with end-stage kidney disease (ESKD) choose hemodialysis (HD) as their kidney replacement therapy (KRT), with few patients opting for peritoneal dialysis (PD) or transplantation. Although recent studies have revealed the implementation of shared decision-making (SDM) for KRT increases the number of patients choosing PD and transplantation, decision changes often occur through the SDM process until the development of ESKD. We thus explored the factors associated with decision changes in patients with advanced chronic kidney disease (CKD) who made a decision for KRT.

Methods

We conducted a cohort study involving 317 CKD patients who underwent KRT discussions through SDM process and provided their decisions between 2019 and 2022. The primary endpoint was a time-to-event analysis for changes from the initial decisions made during SDM, and we identified factors associated with decision changes.

Results

The mean age was 73 ± 12 years, with 192 (61%) being male. The baseline eGFR was 15.3 ± 6.4 mL/min/1.73m² at the time of SDM. The distribution of the initial decisions was as follows: HD for 124 (39%), PD and transplantation for 118 (37%), conservative kidney management (CKM) for 10 (3%), and 65 patients (21%) remained undecided. Eighty-six patients (27%) changed their initial decisions, with a median of 381 days. In the multivariable logistic regression model, factors associated with decision change (odds ratios [95% confidence intervals]) were male (1.85 [1.01–3.36]), having family support (2.44 [1.24-4.77]) and decisions of PD and transplantation (10.9 [4.27–27.6]) and CKM (7.5 [1.48–38.1]). In fact, approximately 30% of patients who initially decided on PD and transplantation or CKM changed to desire for HD treatment during the study period.

Conclusion

Following the KRT discussion through the SDM process, decisions of PD and transplantation or CKM may be changed to another KRT modality.