Shared Decision-Making for Choosing Renal Replacement Therapy

Chronic kidney disease is common worldwide, and the number of patients with end-stage kidney disease (ESKD) is expected to rise over the next decade. These patients must select one of the three main treatments available to them: conservative care, dialysis (hemodialysis or peritoneal dialysis), and kidney transplantation. Hemodialysis can occur in a dialysis center (in-center dialysis) or in a person’s home (home dialysis). The international guidelines support the approach of shared decision-making (SDM) for selecting renal replacement therapy. In this approach, patients and healthcare providers collaborate to make medical decisions that incorporate the patient’s values and preferences in conjunction with the best evidence. However, in some clinical practice, patients feel that they do not receive the full knowledge of all available options or that the selection of certain treatment is not well reasoned. In this chapter, the application of SDM for the selection of renal replacement therapies will be discussed in detail.