Responsum for CKD

{{user.displayName ? user.displayName : user.userName}}
{{ user.userType }}
Welcome to

Responsum for CKD

Already a member?

Sign in   
Do you or someone you know have CKD?

Become part of the foremost online community!

Sign Up Now

Or, download the Responsum for CKD app on your phone

American Journal of Kidney Diseases

American Journal of Kidney Diseases

CKD Patients Test Decision-Making Aid to Help Choose Dialysis Method

CKD Patients Test Decision-Making Aid to Help Choose Dialysis Method

Patients living with advanced kidney disease have tested a tool to aid in the decision-making process about what type of dialysis method is right for them—and the results are in.


Published on {{articlecontent.article.datePublished | formatDate:"MM/dd/yyyy":"UTC"}}
Last reviewed on {{articlecontent.article.lastReviewedDate | formatDate:"MM/dd/yyyy":"UTC"}}

Approximately 100,000 people living with chronic kidney disease (CKD) in the U.S. must choose some form of dialysis each year. The two most common delivery methods are:

  • in-center hemodialysis (HD), which is chosen by about 90% of dialysis patients, and
  • at-home peritoneal dialysis (PD), chosen by approximately 10% of patients. 

There is a wide variety of factors to consider, and studies show that many patients feel ill-informed about their options and ill-equipped to make this important decision. A growing body of research indicates that treatments that are in line with patient preferences lead to better clinical outcomes and improved quality of life. 

In a 2019 study published in the American Journal of Kidney Diseases, CKD patients tested the efficacy of a tool to aid in their dialysis decision-making process.*

What they did

The study was a parallel-group randomized controlled trial (RCT) to test the efficacy of the decision aid on decision-making outcomes. Participants were English-speaking adults (≥ 18 years) in the U.S. with advanced CKD (eGFR < 25)  and internet access.

The decision-making tool provided information concerning: 

  • CKD and its progression 
  • Information about, and comparison/contrast between, HD and PD based on patients’ priorities regarding:
    • Pros and cons of each option, 
    • Options for switching modality, 
    • Potential related lifestyle changes, and 
    • Side effects of both delivery methods
  • An interactive exercise to facilitate the deliberation process. 

 The tool also gathered data on the participants’:

  • Treatment preference
  • Decisional conflict
  • Decision self-efficacy (confidence in making an informed decision)
  • Knowledge
  • Preparation for decision-making (readiness for communicating with practitioners and making a health decision)

What they found

Seven of the 140 participants who started the study (70 in the experimental group and 70 in the control group) did not complete the trial. 

The data revealed that:

  • Both groups had high decisional efficacy scores independent of the decision aid.
  • Decision aid users had lower decisional conflict scores (29.1 vs 42.5 in the control group) and higher average knowledge scores (90.3 vs 76.5 in the control group).
  • Uncertainty about dialysis method choice decreased from 46% to 16% after using the aid.
  • More than 90% of the decision aid users felt that it helped them in their decision-making.

Concerning user experience:

  • 92% of participants found the content balanced regarding treatment options.
  • 87% agreed or strongly agreed that it was relevant to them.
  • 89% said they would recommend it to others.
  • 49% agreed that the aid was extremely helpful in understanding dialysis options.

The aid was effective at helping patients who were unsure of their treatment choice at the outset to feel more certain. It did not make people who had already selected an option to become uncertain or change their selection. 

What it means  

Expanding CKD knowledge through education has been proposed as a way to help overcome barriers to patients’ becoming informed partners with their providers when making critical health decisions. Decision aids, such as the one in this study, can broaden knowledge, increase perception of risks, reduce decisional conflict, and improve participation in shared decision-making. 

Utilization of the decision aid in clinical practice could enable further assessment of its effects on patient engagement and empowerment when choosing a method of dialysis delivery. The decision-making tool could also be used to aid in the dissemination of end-stage kidney disease (ESKD) information to help promote active patient engagement and improve health outcomes. 

*Subramanian, L., Zhao, J., Zee, J., McCall, M., et al. (2019, Apr. 3). Use of a Decision Aid for Patients Considering Peritoneal Dialysis and In-Center Hemodialysis: A Randomized Controlled Trial. American Journal of Kidney Diseases. https://www.ajkd.org/article/S0272-6386(19)30160-X/fulltext

Source: {{articlecontent.article.sourceName}}

 

Join the CKD Community

Receive daily updated expert-reviewed article summaries. Everything you need to know from discoveries, treatments, and living tips!

Already a Responsum member?

Available for Apple iOS and Android