Shared decision-making for kidney replacement therapy: a comprehensive review and a proposed model

Shared decision-making (SDM) enables patients to actively engage in healthcare decisions by ensuring that treatment options align with their values and preferences. The use of SDM is increasingly recognized in the context of selecting kidney replacement therapy (KRT) for patients with chronic kidney disease (CKD). This study reviews the general concept of SDM and global clinical studies on its application in selecting KRT options. Studies have demonstrated the significant benefits of SDM in KRT, including enhanced patient knowledge, satisfaction, autonomy, and increased peritoneal dialysis (PD) selection rates, which may contribute to cost savings. However, challenges remain in implementing SDM owing to time constraints, its dynamic nature, and insufficient incentives. Building on established frameworks, particularly Clayman's six-step model, we propose a new six-step SDM framework tailored to KRT to facilitate its implementation and promote adoption. Further research is required to validate the long-term impacts of SDM, address the heterogeneity of existing interventions, and identify the most effective models for clinical use.