Shared Decision-Making in Renal Replacement Therapy Selection: Patient Perceptions, Preferences, and Influencing Factors in a Nationwide Cross-Sectional Study in Japan

Background Shared decision-making (SDM) is a key process in selecting renal replacement therapy (RRT). This study analyzed SDM perceptions, preferences, and patient- and facility-level factors influencing SDM among Japanese patients with chronic kidney disease (CKD) who selected RRT. Methods We analyzed 475 adult patients with CKD from 49 medical facilities. SDM awareness and recognition, preferences for SDM timing and frequency, discussion content, and desired professional involvement were assessed. Patient- and facility-level factors associated with SDM perceptions were evaluated using Poisson regression with cluster-robust variance estimation. Results The mean age of participants was 67.4 years. Overall, 71%, 24.4%, and 4.4% chose hemodialysis, peritoneal dialysis, and kidney transplantation, respectively. While 81.2% perceived that SDM was performed during RRT selection, only 4.7% were explicitly aware of the concept. Patients prioritized discussions about effects on daily life, financial burden, and family-related concerns. Most preferred SDM initiation when RRT was imminent, conducted over multiple sessions. Many patients valued the involvement of medical social workers and their usual non-nephrologist physicians in addition to nephrologists. Multiple outpatient visits for RRT selection, involving nurse participation and extended consultation times, were significantly associated with SDM perceptions (prevalence ratio: 1.59, 95% confidence interval: 1.05–2.42). Conclusions Many Japanese patients with CKD perceived SDM during RRT selection; however, they had limited awareness of the concept. The findings underscore the importance of establishing a system that facilitates repeated SDM discussions at critical moments for patients. These discussions should emphasize the impact of RRT on patients’ lives and involve a multidisciplinary team.