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Shared decision making and dialysis choice: an observational longitudinal cohort study.
Pernille de-la-Motte1, Victoria Baekager Just Jensen1, Maria Højer Bergum2
1Department of Public Health, Aarhus University, Aarhus, Denmark.
BMC Nephrology
|June 5, 2025
Summary
Shared decision making for dialysis choice led to a high rate of home-based treatment selection and adherence. Most patients initiated dialysis within 11 months, with few deaths before treatment, highlighting the intervention's positive impact on kidney failure care.
Area of Science:
- Nephrology
- Public Health
- Decision Science
Background:
- The 'Shared decision making and dialysis choice' intervention has been integrated into standard care in Danish hospitals since 2018.
- This study aimed to evaluate dialysis modality choices and patient outcomes following this shared decision-making intervention for individuals with kidney failure.
Purpose of the Study:
- To describe the dialysis modality choices made by patients with kidney failure after a shared decision-making intervention.
- To analyze the outcomes associated with these choices, including treatment initiation time, concordance, and mortality.
Main Methods:
- A retrospective observational longitudinal cohort study analyzed data from 484 kidney failure patients between 2018 and 2023.
- Predictors such as frailty, eGFR, BMI, and comorbidity were examined against outcomes like home-based dialysis, time to treatment, concordance, and mortality.
- Statistical analyses included Fisher's exact tests, Wilcoxon rank-sum tests, Aalen-Johansen estimation, logistic regression, and Cox proportional hazards models.
Main Results:
- 68% of patients opted for home-based dialysis, with younger age (≤70), university hospital setting, and partnership being significant predictors.
- Half of the patients started treatment within 11 months; older age (≥70) and higher eGFR (>15 ml/min/1.73 m²) predicted longer initiation times.
- Treatment concordance was high (83%), favored by center-based dialysis, regional hospital, and lower frailty scores. Mortality before treatment initiation was 12%, predicted by frailty and lower BMI (<25 kg/m²).
Conclusions:
- The shared decision-making intervention resulted in a high preference for and initiation of home-based dialysis.
- A significant proportion of patients initiated their chosen dialysis modality within 11 months, with low pre-treatment mortality.
- Routine assessment of frailty and BMI before intervention may further optimize patient care pathways.
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