Patient Decision-Making in Chronic Kidney Disease Management

Effective management of chronic kidney disease (CKD) increasingly rests on engaging patients as active partners in decisions about their care. As CKD progresses through its stages, individuals face choices ranging from the timing of dialysis initiation to selection of modality, consideration of transplantation and conservative management. Decision-making in this context involves weighing clinical benefits and risks, quality of life implications, and personal values such as independence, lifestyle preferences and psychosocial support. Health literacy, cultural background and emotional readiness further shape patients’ ability to absorb complex medical information and navigate trade-offs. Multidisciplinary teams deploy structured education, decision aids and shared decision-making frameworks to facilitate understanding and align treatment options with individual goals. Peer support and ongoing counselling help to address anxiety and uncertainty, enabling patients to revisit choices as their condition evolves. Globally, policies and service models that embed patient-centred approaches have demonstrated improvements in treatment concordance, modality uptake and satisfaction, while reducing unplanned hospital starts. The integration of digital tools, personalised risk communication and community-based resources holds promise for further strengthening engagement across diverse populations. Ultimately, patient-focused decision pathways in CKD management aim to empower individuals, improve health outcomes and optimise resource use in renal care services.

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Patient Decision-Making in Chronic Kidney Disease Management publication trend

The graph below shows the total number of articles in patient decision-making in chronic kidney disease management across all publications each year (not limited to Nature Index journals).

Technical terms

Chronic kidney disease (CKD): A progressive loss of kidney function over months or years, classified into stages based on glomerular filtration rate and clinical features.

Shared decision-making (SDM): A collaborative process in which clinicians and patients exchange information, discuss options and agree on a treatment that aligns with patient values.

Dialysis modality: The specific method of renal replacement therapy, typically haemodialysis (in-centre or home) or peritoneal dialysis, each with distinct lifestyle and clinical implications.

Decision aid: A tool or resource designed to help patients understand treatment options, benefits and risks, often incorporating visuals, narratives and risk calculators.

Renal replacement therapy (RRT): Medical interventions that substitute for lost kidney function, including dialysis modalities and transplantation, to maintain fluid and metabolic balance.

References

1. Peer support for CKD patients and carers: overcoming barriers and facilitating access. Health Expectations (2015).
2. Development of a decision aid to inform patients’ and families’ renal replacement therapy selection decisions. BMC Medical Informatics and Decision Making (2012).
3. Beyond dialysis decisions: a qualitative exploration of decision-making among culturally and linguistically diverse adults with chronic kidney disease on haemodialysis. BMC Nephrology (2018).
4. Choice of dialysis modality: patients’ experiences and quality of decision after shared decision-making. BMC Nephrology (2020).
5. Comparison of shared decision making in patients undergoing hemodialysis and peritoneal dialysis for choosing a dialysis modality. BMC Nephrology (2021).
6. Shared Decision-Making for a Dialysis Modality. Kidney International Reports (2021).