Effects of shared decision-making on the prognosis of peritoneal dialysis patients

Background: Chronic kidney disease (CKD) patients face critical decisions in choosing kidney replacement therapy such as hemodialysis (HD) or peritoneal dialysis (PD), which significantly affect their quality of life and health outcomes. Recent studies highlight the importance of shared decision-making (SDM) in helping patients understand their treatment options and make informed choices. SDM not only improves patient satisfaction and autonomy but also emphasizes the need for comprehensive pre-dialysis education to support optimal treatment selection. Methods: Among patients with chronic kidney failure from 8 hospitals in Korea who started dialysis, 256 who participated in a pilot project for home management of PD were included in the present study. A mixed-methods study was conducted using questionnaires and semi-structured interviews. Our study focused on the effects of SDM on patient death, survival rate, HD conversion, emergency room visits, hospitalization days, and outpatient visits. Results: A significant difference was observed in hospitalization days (P = .0044) between the SDM and non-SDM groups. However, no significant differences were observed in survival rate, rate of conversion to HD, survival rate after conversion to HD, emergency room visit rate, number of hospitalizations per patient, outpatient visit rate, medical cost, hospitalization cost, outpatient cost, and phosphate-binding agent prescription rate. Conclusions: This study emphasizes the benefits of SDM in reducing hospitalization days for PD patients, suggesting its potential role as a guide in future decisions regarding PD. PD provides a particularly beneficial home-based treatment alternative for patients facing challenges with hospital visits, supported by advanced technologies. Overseas, various countries are implementing policies and incentives to promote home dialysis, demonstrating the potential for SDM to enhance patient satisfaction and outcomes in dialysis care globally.