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Background It is critical to ensure that older patients and families understand the risks and benefits of each available treatment option when contemplating kidney therapy (KT) decisions. This study investigates older patients’ and caregivers’ beliefs regarding chronic kidney disease (CKD) curability, anticipated quality of life (QoL) with dialysis, trade-offs between longevity and QoL, frequency of prognostic discussions and views on remaining life expectancy. Methods We conducted secondary analyses of orally administered questionnaire-based data collected in two intervention studies aimed at improving KT decision-making for older adults with advanced CKD. Results We present descriptive statistics to summarize findings. Among 118 patients (mean age 79 years) and 60 caregivers (mean age 68 years), 54% patients and 75% caregivers were women, with 75% patients and 79% caregivers identifying as White. When asked about their CKD curability, nearly 35% patients and 15% caregivers did not know or were unsure, while 10% patients and 12% caregivers expressed optimism. Participants generally lacked clarity on dialysis’s impact on QoL. Furthermore, most participants (85% patients and 92% caregivers) did not have prognostic discussions about life expectancy with their nephrologists and were either uncertain or optimistic about future 1 and 2-year survival rates. Many participants prioritized QoL—functional status (45% vs. 48%), reduced suffering (70% vs. 24%), and fewer hospitalizations (48% vs. 45%)—over choosing dialysis. Conclusion Inaccurate beliefs about CKD curability, the benefits of KT options, lack of prognostic discussions and prognostic uncertainty are common among older adults and caregivers facing treatment decisions, highlighting the need for educational interventions for nephrologists, patients and families.

Background Older patients with advanced chronic kidney disease often do not understand treatment options for renal replacement therapy, conservative kidney management, and advance care planning. It is unclear whether both clinicians and patients have similar perspectives on these treatments and end-of-life care. Thus, the aim of this study was to explore clinician and patient/caregiver perceptions of treatments for end-stage renal disease and advance care planning. Methods This was a qualitative interview study of nephrologists ( n  = 8), primary care physicians ( n  = 8), patients ( n  = 10, ≥ 65 years and estimated glomerular filtration rate < 20), and their caregivers ( n  = 5). Interviews were conducted until thematic saturation was reached. Transcripts were transcribed using TranscribeMe. Using Nvivo 12, we identified key themes via narrative analysis. Results We identified three key areas in which nephrologists’, primary care physicians’, and patients’ expectations and/or experiences did not align: 1) dialysis discussions; 2) dialysis decision-making; and 3) processes of advance care planning. Nephrologist felt most comfortable specifically managing renal disease whereas primary care physicians felt their primary role was to advocate for patients and lead advance care planning discussions. Patients and caregivers had many concerns about the impact of dialysis on their lives and did not fully understand advance care planning. Clinicians’ perspectives were aligned with each other but not with patient/caregivers. Conclusions Our findings highlight the differences in experiences and expectations between clinicians, patients, and their caregivers regarding treatment decisions and advance care planning. Despite clinician agreement on their responsibilities, patients and caregivers were unclear about several aspects of their care. Further research is needed to test feasible models of patient-centered education and communication to ensure that all stakeholders are informed and feel engaged.

Aim. To examine the relationships among nursing professionalism, empathy, and clinical decision-making ability and the factors influencing shared decision-making awareness in hemodialysis nurses. Background. Self-management and treatment for hemodialysis patients are essential for maintaining health and life in daily life. In this process, shared decision-making in which patients, nurses, and medical teams participate and make decisions together has a greater impact on the health recovery and improvement of quality of life for hemodialysis patients than for any other chronic disease patients. Methods. A cross-sectional descriptive design was employed. Participants were 145 nurses working in the hemodialysis centers at hospitals in Seoul and Gyeonggi-do. Measures included the general characteristics of study participants, nursing professionalism, empathy, clinical decision-making ability, and shared decision-making awareness. Data were collected from May to July, 2022, and multiple linear regression analysis was used to examine the predictive factors of shared decision-making awareness. Results. The strongest predictor was empathy, followed by clinical decision-making ability and the level of education. The explanatory power of the final regression model was 23%. Conclusions. Empathy towards hemodialysis patients was an important factor influencing the shared decision-making awareness in hemodialysis nurses. Implications for Nursing Management. In nursing management, nursing managers or nurses should pay attention to influencing factors to improve the shared decision-making awareness of hemodialysis nurses. Empathy towards hemodialysis patients need to be reinforced to improve the shared decision-making awareness of hemodialysis nurses.

Acute kidney injury (AKI) is an increasingly frequent complication among hospitalized children. It is associated with high morbidity and mortality, especially in neonates and children requiring dialysis. The different renal replacement therapy (RRT) options for AKI have expanded from peritoneal dialysis (PD) and intermittent hemodialysis (HD) to continuous RRT (CRRT) and hybrid modalities. Recent advances in the provision of RRT in children allow a higher standard of care for increasingly ill and young patients. In the absence of evidence indicating better survival with any dialysis method, the most appropriate dialysis choice for children with AKI is based on the patient’s characteristics, on dialytic modality performance, and on the institutional resources and local practice. In this review, the available dialysis modalities for pediatric AKI will be discussed, focusing on indications, advantages, and limitations of each of them.

Background 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. Methods 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. Results 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. Conclusions 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.

An increasing number of older patients have to decide on a treatment plan for advanced chronic kidney disease (CKD), involving dialysis or conservative care. Shared decision-making (SDM) is recommended as the model for decision-making in such preference-sensitive decisions. The aim of SDM is to come to decisions that are consistent with the patient’s values and preferences and made by the patient and healthcare professional working together. In clinical practice, however, SDM appears to be not yet routine and needs further implementation. A shift from a biomedical to a person-centered conception might help to make the process more shared. Shared should, therefore, be interpreted as two persons bringing two perspectives to the table, that both need to be explored during the decision-making process. Starting from the patient’s perspective will enable to determine the mutual goals of care first and, subsequently, determine the best way for achieving those goals. To perform such SDM, the healthcare professional needs to become a skilled companion, being part of the patient’s relational context, and start asking the right questions about what matters to the patient as person. In this article, we describe the need for a person-centered conception of SDM for the setting of older patients with advanced CKD.

Vascular access planning guidelines have shifted from a fistula-centered to a patient-centered approach. We advocate for expansion of the shared decision-making dyad between the nephrology team and patient to include other vascular access planning stakeholders. We propose earlier and consistent interprofessional collaboration facilitates more constructive discussions that could improve outcomes.

Background The ‘Shared decision making and dialysis choice’ intervention has been part of usual care at two hospitals in Denmark since 2018. The objective was to describe dialysis modality choice and outcomes for patients with kidney failure who received a shared decision making intervention. Methods Retrospective observational longitudinal cohort study design was used. Data were collected from 2018 to 2023 on 484 patients with kidney failure from one regional and one university hospital. The exposure was a shared decision making intervention for dialysis choice. The predictors were frailty, estimated glomerular filtration rate (eGFR), comorbidity, Body Mass Index (BMI), ethnicity, marital status and smoking. The outcomes were home-based dialysis, time, concordance, and death. Fisher’s exact tests and Wilcoxon rank-sum tests assessed whether choice of dialysis modality differed significantly. Aalen-Johansen estimation assessed time from the shared decision making intervention to treatment initiation, concordance between chosen and initiated treatment, and mortality before treatment initiation. Logistic regression and Cox proportional hazards evaluated the patient characteristics predicting these three outcomes. Results After the intervention, 68% chose home-based dialysis, while 32% chose center-based dialysis. With significant differences, more patients aged ≤ 70 years, at the university hospital, and living with a partner chose home-based dialysis. Half of the patients initiated treatment within 11 months, and predictors for initiating dialysis later than 11 months were age ≥ 70 years and eGFR > 15 ml/min/1.73 m². 83% of the patients received the treatment chosen, and predictors for concordance were center-based dialysis, regional hospital, and very mild to mild frailty. 12% of the patients died before treatment initiation, predicted by very mild to severe frailty and BMI < 25 kg/m². Conclusions A high proportion of patients chose a home-based treatment after receiving the intervention and initiated their preferred dialysis choice. 50% of patients received the intervention 11 months before initiating dialysis, and few patients died before initiating dialysis. Routinely assessing frailty and BMI prior to intervention could possibly improve patient pathways. Complete follow-up for all patients was not ensured.

Congestive heart failure (CHF) is associated with high mortality and a heavy financial and healthcare burden in the dialysis population. Determining which dialysis modality is associated with a higher risk of developing CHF might facilitate clinical decision making and surveillance programs in the dialysis population. Using the Taiwan National Health Insurance Database, we recruited all incident dialysis patients during the period from January 1, 1998 to December 31, 2010. The propensity score matching method was applied to establish the matched hemodialysis (HD) and peritoneal dialysis (PD) cohort. Incidence rates and cumulative incidence rates of CHF-related hospitalization were first compared for the HD and PD patients. Multivariable subdistribution hazards models were then constructed to control for potential confounders. Among a total of 65,899 enrolled dialysis patients, 4,754 matched pairs of HD and PD patients were identified. The incidence rates of CHF in the matched HD and PD patients were 25.98 and 19.71 per 1000 patient-years, respectively (P = 0.001). The cumulative incidence rate of CHF was also higher in the matched HD patients (0.16, 95% confidence interval (CI)(0.12-0.21)] than in the corresponding PD patients (0.09, 95% CI [0.08-0.11])(P<0.0001). HD was consistently associated with an increased subdistribution hazard ratio (HR) of CHF compared with PD in the matched cohort (HR: 1.45, 95% CI [1.23-1.7]). Similar phenomenons were observed in either the subgroup analysis stratified by selected confounders or in the HD and PD group without matching. HD is associated with a higher risk of developing CHF-related hospitalization than PD. The surveillance program for CHF should differ in patients receiving different dialysis modalities.

Background End‐stage renal disease (ESRD) is increasing both globally and in Asia. Singapore has the fifth highest incidence of ESRD worldwide, a trend that is predicted to rise. Older patients with ESRD are faced with a choice of haemodialysis, peritoneal dialysis or conservative management, all of which have their risks and benefits. Objective This study seeks to explore perspectives on decision making amongst older (≥70) Singaporean ESRD patients and their caregivers to undergo (or not to undergo) dialysis. Design Qualitative study design using semi‐structured interviews. Setting and participants Twenty‐three participants were recruited from the largest tertiary hospital in Singapore: seven peritoneal dialysis patients, five haemodialysis patients, four patients on conservative management and seven caregivers. Results While some patients believed that they had made an independent treatment decision, others reported feeling like they had no choice in the matter or that they were strongly persuaded by their doctors and/or family members to undergo dialysis. Patients reported decision‐making factors including loss of autonomy in daily life, financial burden (on themselves or on their families), caregiving burden, alternative medicine, symptoms and disease progression. Caregivers also reported concerns about financial and caregiving burden. Discussion and conclusion This study has identified several factors that should be considered in the design and implementation of decision aids to help older ESRD patients in Singapore make informed treatment decisions, including patients' and caregivers' decision‐making factors as well as the relational dynamics between patients, caregivers and doctors.