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.