# Effectiveness of a shared decision-making program in reducing unplanned dialysis in advanced chronic kidney disease: a retrospective cohort study

## TL;DR

A shared decision-making program significantly reduced unplanned dialysis in patients with advanced kidney disease.

## Contribution

The study demonstrates the effectiveness of a shared decision-making program in reducing unplanned dialysis in advanced chronic kidney disease.

## Key findings

- The SDM group had a 33.3% unplanned dialysis rate, significantly lower than the 66.7% in the usual care group.
- Participation in the SDM program was a strong protective factor against unplanned dialysis.
- Peritoneal dialysis and higher serum albumin levels at dialysis initiation also reduced unplanned dialysis rates.

## Abstract

To evaluate the effectiveness of a Shared Decision-Making (SDM) program in reducing unplanned dialysis among patients with advanced chronic kidney disease (CKD) and to identify factors predictive of unplanned dialysis.

This retrospective cohort study was conducted at Phanatnikhom Hospital in Chonburi, Thailand, from October 2021 to September 2023. Patients aged 18 years and older with CKD stages 4 and 5 who were receiving renal replacement therapy (RRT) were included. Starting in October 2022, the Shared Decision-Making (SDM) program was implemented as the standard of care. Baseline demographic data, dialysis modalities, and the incidence of unplanned dialysis were collected. Unplanned dialysis was defined as dialysis initiated through a temporary catheter or within a short time frame after the initial dialysis decision.

Among 111 patients, 66 received SDM, and 45 received usual care. The incidence of unplanned dialysis was significantly lower in the SDM group compared to the usual care group (33.3% vs. 66.7%, p < 0.001). Multivariate analysis indicated that participation in the SDM program (OR = 0.19, p = 0.001), peritoneal dialysis (OR = 0.26, p = 0.032), and higher serum albumin at the initiation of dialysis (OR = 0.33, p = 0.014) were protective factors against unplanned dialysis.

The SDM program effectively reduces unplanned dialysis in patients with advanced CKD by aligning medical decisions with patient preferences and priorities. Peritoneal dialysis and higher serum albumin levels at dialysis initiation are also associated with lower rates of unplanned dialysis.