A shared decision-making approach to selecting renal replacement therapies could increase the number of elderly patients who choose peritoneal dialysis

Abstract

[Objectives] In Japan, most patients who require renal replacement therapy (RRT) choose to undergo hemodialysis (HD), and only 2.7% of patients choose to undergo peritoneal dialysis (PD). In 2011, dialysis nurses at our hospital started to provide patients with explanations about RRT in an outpatient setting based on a shared decision-making (SDM) approach in order to facilitate the selection of appropriate RRT modalities. We investigated whether more patients, especially elderly patients, selected PD after receiving a detailed explanation about RRT. [Methods] The subjects of this study were 637 consecutive patients (mean age: 67.0±12.7 years) who required RRT at our hospital during the period from January 1, 2013, to December 31, 2018. We retrospectively investigated the first RRT modality selected by the patients and whether the patients received an explanation about RRT. [Results] The 637 patients were divided into two groups: patients who received an explanation about RRT (SDM group, n=387) and patients who did not receive an explanation about RRT (non-SDM group, n=250). The percentage of patients who selected PD was significantly higher in the SDM group than in the non-SDM group (30.7% vs. 16.8%, p<0.001). When the analysis was restricted to patients aged ≥75 years, the percentage of patients who selected PD was still significantly higher in the SDM group (25.0%, n=112) than in the non-SDM group (7.8%, n=90) (p=0.001). [Conclusion] This study suggested that more patients, including elderly patients, would select PD if detailed explanations about RRT were provided via a SDM approach. These results are important considering the current aging of the population in Japan.