Shared Decision Making for Choosing renAl Replacement Therapy in Chronic Kidney Disease Patients (SDM-ART trial): study protocol for randomized clinical trial

Abstract

Background: Patients with chronic kidney disease (CKD) should be educated about their condition so that they can initiate dialysis at the optimal time and make an informed choice between dialysis modalities. Shared decision-making (SDM) empowers patients to select their own treatment and improves patient outcomes. This study aimed to evaluate whether SDM affects the choice of renal replacement therapy among CKD patients. Methods: This is a multicenter, open-label, randomized, pragmatic clinical trial. A total of 1,194 participants with CKD who are considering renal replacement therapy were enrolled. The participants will be randomized into three groups in a 1:1:1 ratio: the conventional group, extensive informed decision-making group, and SDM group. Participants will be educated twice at months 0 and 2. Videos and leaflets will be provided to all patients. Patients in the conventional group will receive 5 minutes of education at each visit. The extensive informed decision-making group will receive more informed and detailed education using intensive learning materials for 10 minutes each visit. Patients in the SDM group will be educated for 10 minutes each visit according to illness perception and item-based analysis. The primary endpoint is the ratio of hemodialysis to peritoneal dialysis and kidney transplantation among the groups. Secondary outcomes include unplanned dialysis, economic efficiency, patient satisfaction, patient evaluation of the process, and patient adherence. Discussion: The SDM-ART is an ongoing clinical study to investigate the effect of SDM on the choice of renal replacement therapy in patients with CKD.

Status and trends in epidemiologic characteristics of diabetic end-stage renal disease: an analysis of the 2021 Korean Renal Data System

“…Our analysis indicates that nondiabetic CKD 5PD patients exhibited lower mortality rates than those who received HD, with the former subgroup displaying the lowest mortality rate among all analyzed groups. Consequently, optimal patient selection and effective management of PD may result in superior outcomes for diabetic CKD 5D patients relative to HD, emphasizing the importance of shared decision-making [13] between healthcare providers and patients when selecting the most appropriate RRT modality [14][15][16][17]. Nonetheless, further efforts are imperative to improve the survival outcomes of diabetic CKD 5PD, as this subgroup continues to exhibit the highest mortality rate among the four groups.…”

Ongoing Peritoneal Dialysis Training at Home Allows for the Improvement of Patients’ Empowerment: A Single Center Experience

“…Not all these patients will have the opportunity to undergo a kidney transplant, necessitating a decision regarding the choice of dialysis modality: hemodialysis (HD) or peritoneal dialysis (PD). The guidelines recommend involving the patient and their relatives in the decision-making process, while healthcare professionals analyze the various medical, social, and economic factors [4,5]. Although no clear superiority of one method over the other has been established, PD offers several advantages.…”