Shared decision-making and non-hemodialysis kidney replacement therapy selection in end-stage kidney disease: a quasi-experimental, difference-in-differences study
In brief
Participating physicians saw non-HD kidney choices reach 48.5%, versus 21.9%
In this 556-patient study, patients treated by physicians participating in a structured shared decision-making program more often chose peritoneal dialysis or a transplant over hemodialysis during the program period: 48.5% versus 21.9%. The adjusted association was driven mainly by transplant choices, not peritoneal dialysis, and unplanned dialysis did not decline; other centers need to confirm the findings.
- Journal
- Kidney research and clinical practice (Q1)
- Published
- 30 October 2026
- Study design
- Non-randomized / quasi-experimental trial
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Hyun Jung Shin, Jinyeong Yi, Julee You, Eun Mi You, Sugeun Kim, Eun-Jeong Kwon, et al.
- PMID
- 42968233
- DOI
- 10.23876/j.krcp.26.103
Why clinicians should know about it
- Picked for Nephrology (paper of the day, 4 November 2026): Shared decision-making affects dialysis modality and transplant selection
Abstract
BACKGROUND: Shared decision-making (SDM) is essential in selecting kidney replacement therapy, yet its impact within Korea's hemodialysis (HD)-dominant environment remains unclear. This study evaluated whether a structured SDM program was associated with the selection of peritoneal dialysis (PD) or kidney transplantation (KT) over HD after accounting for secular trends. METHODS: We conducted a retrospective cohort study of patients with advanced chronic kidney disease at a tertiary center (2017- 2022). Using a quasi-experimental, difference-in-differences design, patients were grouped by SDM period and physician participation. The primary outcome was selecting PD or KT over HD; the secondary outcome was unplanned dialysis. Multivariable logistic regression models included an interaction term between SDM period and physician participation. RESULTS: Among 556 patients, pre-SDM modality distributions were similar between physician groups. During the SDM period, patients managed by SDM-participating physicians more often selected PD or KT (48.5% vs. 21.9%). The fully adjusted interaction was significant for the primary composite outcome of PD or KT selection (odds ratio [OR], 3.49; 95% confidence interval [CI], 1.16- 10.54; p = 0.027). In separate analyses, the interaction was significant for KT selection (OR, 4.43; 95% CI, 1.38-14.26) but not for PD selection (OR, 0.82; 95% CI, 0.16-4.19), indicating that KT primarily drove the composite association. The interaction term was not significantly associated with unplanned dialysis. CONCLUSION: A structured SDM program was associated with increased PD or KT selection beyond secular trends, contingent upon participating physicians. This association was driven primarily by KT rather than PD. Unplanned dialysis was not reduced, and further multicenter validation is warranted.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.