MO1046: The Selection of Renal Replacement Therapy for End-Stage Kidney Disease Patients by the Shared Decision-Making Method

Abstract

Abstract BACKGROUND AND AIMS In Japan, > 97% of patients with end-stage kidney disease (ESKD) select hemodialysis as a renal replacement therapy (RRT). Hemodialysis (HD) and peritoneal dialysis (PD) have been provided at our hospital for many years, and kidney transplantation (KT) has been available here since 2015. In January 2018, we introduced the option of RRT for outpatients based on the shared decision-making (SDM) method, which was recently shown to be useful for patients. METHOD Patients receive ∼1-h explanation of the SDM method by a nurse in the outpatient department. If patients desire additional outpatient visits, they receive as many as they want; a decision about RRT is not required after a single visit and patients can change their decision at any time. We conducted a prospective observational study to investigate patients’ selection of RRT and the influence of the SDM method on the selection of RRT. The data were examined by Fisher's exact test and significance was accepted at P < 0.05. RESULTS During the period from January 2018 to December 2021, 116 patients visited our outpatient department and 69 patients underwent RRT. Only 53% of the patients initially requested hemodialysis (Figure 1), but > 80% of the patients eventually underwent hemodialysis (Figure 2). From 2018 to 2021, 156 patients started RRT; 58 of them (37%) had visited the outpatient department before starting RRT. The number of patients who visited the outpatient department has increased year by year. The emergency initiation of dialysis decreased significantly after the outpatient use of the SDM method began [odds ratio (OR) 0.44, P = 0.024]. CONCLUSION There was a tendency for patients’ satisfaction regarding their own selection of RRT via the SDM method in the outpatient department. Patients can obtain the information they need and select a better treatment for themselves via an explanation of the SDM method. The SDM method is thus very effective for both patients and medical staff when considering RRT.