Shared decision making and decision aids in the management of kidney disease and renal replacement treatment options

Purpose of review To examine recent developments in shared decision making (SDM) interventions for advanced chronic kidney disease (CKD) and end-stage kidney disease (ESKD). Given the complexity of treatment decisions and low patient engagement despite available options, SDM is a critical approach to improve treatment initiation and engagement. Recent findings Three recent SDM interventions were identified: DART (Decision-Aid for Renal Therapy), a decision support patient-centered video tool for older patients with stages 4–5 CKD that significantly reduced decisional conflict and improved treatment knowledge; YoDCA (Yorkshire Dialysis and Conservative Care Aid), a 28-page patient-centered decision support tool supporting dialysis versus conservative management decisions; and SIMPLIFY-HD (Stroke-Prevention Strategies in Patients With Atrial Fibrillation Receiving Maintenance Hemodialysis), an encounter-based decision aid for patient-provider use. These interventions demonstrated improved decision quality, reduced decisional conflict, and enhanced patient knowledge. Summary While recent advances show promise for enhancing patient knowledge and decision-making among older adults with kidney disease, significant gaps remain. Limited real-world testing, narrow focus on older populations with late-stage disease, and insufficient integration of multimorbidity present implementation challenges. Future research should prioritize rigorous randomized controlled trials, broader patient inclusion, multimorbidity integration, clinician training, and assessment of long-term clinical outcomes to achieve patient-centered kidney care.