A Patient Decision Aid About Conservative Kidney Management in Advanced Kidney Disease: A Randomized Pilot Trial

Abstract

Rationale & Objective: Available decision aids for patients about treatment of advanced chronic kidney disease (CKD) often lack information on conservative kidney management (CKM). We assessed the feasibility and acceptability of a decision aid on CKM among patients with advanced CKD and their family members. Study Design: Randomized pilot trial. Setting & Participants: Patients aged ≥75 years with stage 4 or 5 CKD and their family members at 4 medical centers in the greater Seattle area between August 2020 and December 2021. Interventions: Usual care with or without a decision aid on CKM. Outcome: Acceptability was assessed by attrition rates between the initial study visit (T1) and the 3-month follow-up evaluation (T3). The primary outcome and measure of feasibility was the proportion of participants who discussed CKM with a health care provider between T1 and T3. Results: We randomized 92 patients of whom 86 (55.8% male; age 82 ± 6 years; 82.6% White) completed T1—42 in the usual care arm and 44 in the usual care plus decision aid arm—and 56 family members of whom 53 (18.9% male; age 71 ± 11 years; 86.8% White) completed T1—20 in usual care arm and 33 in the usual care plus decisions aid arm. The attrition rates were 21% versus 21% (P = 1.0) for patients, and 10% versus 18% (P = 0.46) for family members in the usual care versus usual care plus decisions aid arms. Receipt of the decision aid significantly increased discussion of CKM with a health care provider for patients (26.4% vs 3.0%, P = 0.007) and family members (26.9% vs 0, P = 0.02). Limitations: Possible limited generalizability because participants were a relatively homogenous group. The decision aid focuses on CKM and may be less applicable to those with limited knowledge of kidney replacement therapies. Conclusions: A CKM decision aid was feasible and acceptable, and increased discussion of this treatment option with health care providers. This aid may serve as a useful adjunct to the currently available educational tools on treatments for advanced CKD. Funding: Grant from a not-for-profit entity (National Palliative Care Research Center). Trial Registration: Registered at ClinicalTrials.gov with study number NCT04919941.