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

Shared Decision-Making in Renal Replacement Therapy Selection: Patient Perceptions, Preferences, and Influencing Factors in a Nationwide Cross-Sectional Study in Japan | medRxiv /* */ /* */ <!-- <!-- /*! * yepnope1.5.4 * (c) WTFPL, GPLv2 */ (function(a,b,c){function d(a){return"[object Function]"==o.call(a)}function e(a){return"string"==typeof a}function f(){}function g(a){return!a||"loaded"==a||"complete"==a||"uninitialized"==a}function h(){var a=p.shift();q=1,a?a.t?m(function(){("c"==a.t?B.injectCss:B.injectJs)(a.s,0,a.a,a.x,a.e,1)},0):(a(),h()):q=0}function i(a,c,d,e,f,i,j){function k(b){if(!o&&g(l.readyState)&&(u.r=o=1,!q&&h(),l.onload=l.onreadystatechange=null,b)){"img"!=a&&m(function(){t.removeChild(l)},50);for(var d in y[c])y[c].hasOwnProperty(d)&&y[c][d].onload()}}var 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Tatsunori Toida , View ORCID Profile Tomo Suzuki , View ORCID Profile Hiroki Nishiwaki , Kenichiro Asano , View ORCID Profile Hiroyuki Terawaki , View ORCID Profile Takafumi Ito , View ORCID Profile Hideaki Oka , View ORCID Profile Kei Nagai , View ORCID Profile Minoru Murakami , Kojiro Nagai , Daisuke Komukai , Takayuki Adachi , Satoshi Furukata , Takaaki Tsutsui , View ORCID Profile Kiichiro Fujisaki , Seita Sugitani , Hideaki Shimizu , Tomoya Nishino , Hiroaki Asada , Hideki Shimizu , Tatsuo Tsukamoto , View ORCID Profile Izaya Nakaya , View ORCID Profile Yosuke Yamada , View ORCID Profile Ryohei Inanaga , Shohei Yamada , Shohei Nakanishi , Atsuhiro Maeda , View ORCID Profile Mari Yamamoto , Shuma Hirashio , Takeshi Okamoto , Takayuki Nakamura , View ORCID Profile Ken-ichi Miyoshi , Hiroshi Kado , Susumu Toda , View ORCID Profile Shigeru Shibata , Keiko Nishi , Makoto Yamamoto , Tsukasa Naganuma , Ryo Zamami , Masahide Furusho , Hitoshi Miyasato , Yukihiro Tamura , View ORCID Profile Yoshihiko Raita , Chisato Fukuhara , View ORCID Profile Keita Uehara , Kosuke Inoue , Yasuhiro Taki , Nobuyuki Nakano , View ORCID Profile Noriaki Kurita , the PREPARES Study Group doi: https://doi.org/10.1101/2025.01.11.25320378 Yugo Shibagaki 1 Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine , Kawasaki-city, Kanagawa, Japan MD, PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Tadashi Sofue 2 Department of Cardiorenal and Cerebrovascular Medicine, Faculty of Medicine, Kagawa University , Miki-cho, Kita-gun, Kagawa, Japan MD, PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Tadashi Sofue Hiroo Kawarazaki 3 Department of Internal Medicine, Division of Nephrology, Teikyo University Hospital Mizonokuchi , Kawasaki-city, Kanagawa, Japan MD, PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Hiroo Kawarazaki Tatsunori Toida 4 School of Pharmaceutical Sciences, Kyushu University of Medical Science , Nobeoka-city, Miyazaki, Japan MD, PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Tatsunori Toida Tomo Suzuki 5 Department of Nephrology, Kameda Medical Center , Kamogawa-City, Chiba, Japan MD, PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Tomo Suzuki Hiroki Nishiwaki 6 Division of Nephrology, Department of Internal Medicine, Showa University Fujigaoka Hospital , Yokohama-City, Kanagawa, Japan MD, MPH, PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Hiroki Nishiwaki Kenichiro Asano 7 Department of Nephrology, Kurashiki Central Hospital , Kurashiki-City, Okayama, Japan MD, PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Hiroyuki Terawaki 8 Department of Internal Medicine , Nephrology, Teikyo University Chiba Medical Center , Ichihara-city, Chiba, Japan MD, PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Hiroyuki Terawaki Takafumi Ito 8 Department of Internal Medicine , Nephrology, Teikyo University Chiba Medical Center , Ichihara-city, Chiba, Japan MD, PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Takafumi Ito Hideaki Oka 9 Department of Nephrology, Matsuyama Red Cross Hospital , Matsuyama-City, Ehime, Japan MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Hideaki Oka Kei Nagai 10 Department of Nephrology, Hitachi General Hospital , Hitachi-City, Ibaraki, Japan MD, PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Kei Nagai Minoru Murakami 11 Department of Nephrology, Saku Central Hospital , Saku-city, Nagano, Japan MD, MPH Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Minoru Murakami Kojiro Nagai 12 Department of Nephrology, Shizuoka General Hospital , Shizuoka-City, Shizuoka, Japan MD, PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Daisuke Komukai 13 Department of Nephrology, Kawasaki Saiwai Hospital , Kawasaki-city, Kanagawa, Japan MD, PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Takayuki Adachi 14 Department of Nephrology, Social Medical Corporation Yuuaikai Yuuai Medical Center , Tomigusuku-City, Okinawa, Japan MD, PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Satoshi Furukata 15 Department of Nephrology, Fukaya Red Cross Hospital , Fukaya-City, Saitama, Japan MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Takaaki Tsutsui 16 Kidney Disease and Dialysis Center, Hidaka Hospital , Hidaka-kai, Takasaki-city, Gunma, Japan MD, PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Kiichiro Fujisaki 17 Department of Nephrology, Iizuka Hospital , Iizuka-City, Fukuoka, Japan MD, PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Kiichiro Fujisaki Seita Sugitani 18 Department of Nephrology, Japanese Red Cross Wakayama Medical Center , Wakayama- City, Wakayama, Japan MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Hideaki Shimizu 19 Department of Nephrology, Daido Hospital , Nagoya-City, Aichi, Japan MD, PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Tomoya Nishino 20 Department of Nephrology, Nagasaki University Hospital , Nagasaki-City, Nagasaki, Japan MD, PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Hiroaki Asada 21 Department of Nephrology, Okazaki City Hospital , Okazaki-City, Aichi, Japan MD, PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Hideki Shimizu 22 Department of Nephrology, Funabashi Municipal Medical Center , Funabashi-city, Chiba, Japan MD, PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Tatsuo Tsukamoto 23 Medical Research Institute Kitano Hospital , PIIF Tazuke-Kofukai, Osaka-city, Osaka, Japan MD, PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Izaya Nakaya 24 Department of Nephrology and Rheumatology, Iwate Prefectural Central Hospital , Morioka-city, Iwate, Japan MD, PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Izaya Nakaya Yosuke Yamada 25 Department of Nephrology, Aizawa Hospital , Matsumoto-City, Nagano, Japan MD, PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Yosuke Yamada Ryohei Inanaga 26 Department of Nephrology, Shin-Yurigaoka General Hospital , Kawasaki-City, Kanagawa, Japan MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Ryohei Inanaga Shohei Yamada 27 Department of Nephrology, Japanese Red Cross Medical Center , Shibuya-ku, Tokyo, Japan MD, PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Shohei Nakanishi 28 Department of Nephrology, Hyogo Prefectural Harima-Himeji General Medical Center , Himeji-City, Hyogo, Japan MD, PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Atsuhiro Maeda 29 Department of Nephrology and Dialysis Center, Kouzenkai-Maeda Hospital , Imari-City, Saga, Japan MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Mari Yamamoto 30 Department of Rheumatology and Nephrology, Chubu Rosai Hospital , Nagoya-City, Aichi, Japan MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Mari Yamamoto Shuma Hirashio 31 Department of Nephrology, NHO Hiroshimanishi Medical Center , Otake-City, Hiroshima, Japan MD, PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Takeshi Okamoto 32 Division of Nephrology. Nagoya Ekisaikai Hospital , Nagoya-City, Aichi, Japan MD, PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Takayuki Nakamura 33 Department of Urology, JCHO Nihonmatsu Hospital , Nihonmatsu-city, Fukushima, Japan MD, PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Ken-ichi Miyoshi 34 Department of Cardiology , Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine , Toon, Ehime, Japan MD, PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Ken-ichi Miyoshi Hiroshi Kado 35 Department of Nephrology, Omihachiman Community Medical Center , Omihachiman-City, Shiga, Japan MD, PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Susumu Toda 36 Division of Nephrology, Department of Internal Medicine, Uji Takeda Hospital , Uji-City, Kyoto, Japan MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Shigeru Shibata 37 Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine , Itabashi-Ku, Tokyo, JAPAN MD, PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Shigeru Shibata Keiko Nishi 38 Department of Nephrology, Ogawa Clinic , Nobeoka-City, Miyazaki, Japan MD, PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Makoto Yamamoto 39 Department of Internal Medicine, Okinawa Miyako Hospital , Miyakojima-City, Okinawa, Japan MD, PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Tsukasa Naganuma 40 Department of Nephrology, Yamanashi Prefectural Central Hospital , Kofu-City, Yamanashi, Japan MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Ryo Zamami 41 Department of Cardiovascular Medicine , Nephrology and Neurology, University of the Ryukyus , Nishihara-cho, Okinawa, Japan MD, PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Masahide Furusho 42 Department of Nephrology, National Hospital Organization Kagoshima Medical Center , Kagoshima-City, Kagoshima, Japan MD, MBA Find this author on Google Scholar Find this author on PubMed Search for this author on this site Hitoshi Miyasato 43 Department of Internal Medicine, Okinawa Prefectural Yaeyama Hospital , Ishigaki-city, Okinawa, Japan MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Yukihiro Tamura 44 Department of Internal Medicine, Oosumikanoya Hospital , Kanoya-City, Kagoshima, Japan MD, PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Yoshihiko Raita 45 Department of Nephrology, Okinawa Prefectural Chubu Hospital , Uruma-City, Okinawa, Japan MD, MPH, MMSc Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Yoshihiko Raita Chisato Fukuhara 46 Department of Nephrology, Heartlife Hospital , Nakagusuku-village, Nakagami-gun, Okinawa MD, PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Keita Uehara 47 Department of Internal Medicine, Division of Nephrology and Rheumatology, Regional Independent Administrative Corporation Naha City Hospital , Naha-City, Okinawa, Japan MD, PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Keita Uehara Kosuke Inoue 48 Division of Nephrology, Kochi Memorial Hospital , Kochi-city, Kochi, Japan MD, PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Yasuhiro Taki 49 Department of Nephrology, Inagi Municipal Hospital , Inagi-City, Tokyo, Japan MD, PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Nobuyuki Nakano 50 Division of Internal Medicine, Clinic of Utsunomiya Jinn-naika-hifuka , Utsunomiya, Tochigi, Japan MD, PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Noriaki Kurita 51 Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University , Fukushima-city, Fukushima, Japan MD, PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Noriaki Kurita For correspondence: kuritanoriaki{at}gmail.com Abstract Full Text Info/History Metrics Supplementary material Data/Code Preview PDF Abstract 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. Introduction The decision-making process for patients with chronic kidney disease (CKD) to select a renal replacement therapy (RRT) modality, such as hemodialysis, peritoneal dialysis, or renal transplantation, is a critical issue. A transition from informed choice to shared decision-making (SDM) has been recommended, as each RRT option is considered a reasonable alternative depending on the patient’s circumstances. 1 SDM is a collaborative approach in which physicians and patients work together to choose an RRT modality, with the patient contributing expertise on their individual circumstances, values, and goals, and the physician providing expertise on the disease and the risks and benefits of the available treatments. 2 SDM can reduce regret associated with RRT selection 3 and may improve treatment adherence, 4 reduce emergency hospitalizations, and enhance overall prognosis. 5 , 6 However, the optimal timing for initiating SDM, content of discussions, appropriate participants, and factors influencing RRT selection via SDM remain poorly understood. First, patients with CKD and their physicians face significant challenges in deciding the timing and scope for discussing the choice of RRT. 2 When kidney failure is not imminent, patients may perceive RRT as a distant concern. 2 Second, patients often prioritize the impact of RRT on daily life—such as social participation and employment—over life-sustaining benefits and risks associated with the therapy. 7 Third, decision-making participants may extend beyond the patients themselves and their nephrologists. While patient autonomy is emphasized in the United States and Europe, with family involvement viewed as either beneficial or detrimental to RRT decision-making, 3 , 8 in Asia, including Japan, family involvement is often considered indispensable. 4 , 9 Additionally, some patients seek advice from non-nephrologist healthcare providers with whom they have established long-term relationships. 2 Fourth, while most discussions on promoting SDM focus on patients and healthcare providers, there is growing recognition of the need to address system-level factors, such as the involvement of multidisciplinary healthcare teams and the medical reimbursement system. 8 For instance, the Japanese government reimburses outpatient visits for RRT selection if certain facility requirements are met; however, we do not know whether this policy facilitates SDM implementation. Clarifying these aspects is essential for advancing SDM implementation. Therefore, we conducted a nationwide cross-sectional study involving Japanese adults with CKD who had chosen an RRT modality but had not yet initiated treatment. Materials and Methods Design, setting, and participants This multicenter cross-sectional study was conducted between October 2022 and September 2024 at 49 facilities across Japan providing outpatient care for patients with CKD, including dialysis initiation and, at some sites, renal transplantation (Supplementary Figure S1). The study sites included affiliated facilities where alumni of the primary investigator’s department practice, nearby facilities in the Kanto, Shikoku, and Kyushu regions where co-investigators work, and other facilities with participating nephrologists connected to the research team. These facilities were invited to participate based on personal networks within the nephrology community. The eligibility criteria were: (1) adult patients with stage 5 CKD, (2) those who had selected one of the modalities of RRT, and (3) those who had not yet initiated that RRT. Exclusion criteria were (1) patients in whom RRT was emergently initiated before the choice of RRT was made, (2) patients who were too impaired in physical or cognitive function to complete the questionnaire, or (3) patients who chose conservative kidney management. Patients were rewarded with a 500-yen gift card for completing the questionnaire. The study was approved by the Fukushima Medical University Certified Review Board, Fukushima Medical University (No. ippan-2022). The questionnaire regarding the choice of RRT and SDM The self-administered questionnaire, detailed in Supplementary Items S2 to S4, was developed by the study authors. This questionnaire included items on participant demographics (e.g., education, income, employment status), chosen RRT modality, medical conditions discussed for selection of and preparation for RRT, foundational knowledge on SDM, preferred healthcare provider involvement in SDM, desired information for SDM, and the timing and frequency of discussion using SDM. Both paper and digital versions of the questionnaire were offered, with digital responses enabled via a QR code link on the paper form. Participants were assured that their responses would remain confidential and would not be reviewed by their attending physicians. This policy was upheld through oversight by principal investigators at each site. Responses submitted via paper were directed to a centralized analysis facility for processing and data integration. Collecting clinical and facility data Facility characteristics and clinical data were collected from treating physicians. Patient data included age, sex, primary cause of end-stage kidney disease (ESKD), frailty (as assessed by the Japanese version of the Clinical Frailty Scale, version 2.0 10 , 11 ), and the number of outpatient visits for RRT selection. Outpatient visits for RRT selection required the involvement of nursing staff and a minimum consultation time of 30 minutes. However, these visits did not need to be separate from regular nephrology follow-up appointments. Additionally, the facility providing these services was not required to meet specific criteria to claim teaching and management fees for RRT under Japan’s unique reimbursement system, which allows up to two claims per patient. For example, the facility did not need to have a prior history of claiming reimbursement for peritoneal dialysis teaching and management. The facility characteristics included the total number of beds, the typical annual volume of RRT initiations, the actual volume of RRT initiations in the most recent quarter, the availability of specialized outpatient visits for RRT selection, the frequency of multi-professional healthcare provider involvement in RRT selection discussions, and the types of physicians participating in this process. Statistical analysis All statistical analyses were performed using Stata/SE version 18. For summarizing patient characteristics, facility characteristics, and responses regarding SDM, continuous variables were described as means and standard deviations, and categorical variables were described as frequencies and percentages. Sankey diagrams were created to visually represent the distribution of the combined frequency of SDM initiation timing and implementation frequency before RRT selection, as well as the combined frequency of SDM implementation frequency after RRT selection but prior to initiation, and the willingness to engage in SDM following RRT initiation. 12 The potential factors associated with strong agreement with having the choice of RRT through the SDM approach were studied via exploratory analysis. For this, we fit a Poisson regression with cluster-robust variance estimation with facilities as cluster units to estimate the prevalence ratio of the strong agreement. 13 This rationale is based on the fact that, unlike odds ratios, the ratio of proportions of strong agreement can be estimated without overestimating the ratio when strong agreement is not rare. Candidate predictors were chosen based on our clinical expertise and forced into the model. For any predictor with missing values, multiple imputation with chained equations was performed assuming that the missing values were at random. Estimates from 10 imputed data were combined into a single estimate. Results Participant Characteristics The patient (N = 475) characteristics are summarized in Table 1 . The mean age was 67.4 years (SD, 13.1), 4–5 years younger than the average age of patients undergoing incident dialysis in Japan, based on data from the Japanese Society for Dialysis Therapy (JSDT) registry as of 2022. 14 Overall, 65.3% of participants were male, and the leading causes of ESKD were diabetic kidney disease (38.1%), nephrosclerosis (21.1%), and chronic glomerulonephritis (19.8%), and sex distribution, and primary causes of ESKD were comparable with those of the general Japanese incident dialysis population. 14 More than half of the participants had an education level of high school or below (62.1%) and an annual household income below 5 million yen (63.8%). Nearly 60% were retired or unemployed, while 38.4% were currently working. Based on the clinical frailty scale, approximately 20% of participants were classified as having frailty. Regarding RRT modality, 71.0%, 24.4%, and 4.4% of participants selected hemodialysis, peritoneal dialysis, and kidney transplantation, respectively, suggesting a higher rate of non-hemodialysis selection than the national average. 14 Overall, 44.2% of patients had a single outpatient visit for RRT selection, while 30.3% attended two or more visits. View this table: View inline View popup Table 1. Patient characteristics Facility Characteristics The participating facilities varied in bed capacity: 4.1% were clinics, and 8.2%, 18.4%, and 69.4% were low-, low-to-moderate, and moderate-to-high capacity hospitals ( Table 2 ). Specialized outpatient visits for RRT selection were available at 65.3% of the facilities. Regarding multi-professional participation in explaining RRT options, two-thirds of facilities (67.4%) reported that multi-professional teams were not involved 70–80% of the time. For physician involvement, in 87.8% of the facilities, the patient’s usual physician was responsible for explaining RRT options most of the time (70–80% of the time). View this table: View inline View popup Download powerpoint Table 2. Facility characteristics Patient response to items regarding SDM Awareness of SDM and perception of SDM process for RRT selection Familiarity with SDM varied considerably ( Table 3 ). Only a small proportion (4.7%) reported being well aware of SDM, with an additional 18.4% somewhat aware of the approach. A majority (57.7%) were completely unaware of the approach. A substantial proportion indicated a positive perception regarding SDM process for RRT selection, with 39.1% strongly agreeing and 42.1% somewhat agreeing. View this table: View inline View popup Download powerpoint Table 3. Patient response to questionnaire items regarding SDM Additional Information Desired During SDM Patients expressed interest in discussing a range of factors beyond specific treatment details. These most frequently included daily living restrictions (66.7%) and financial burdens associated with each treatment (61.9%), followed by information regarding the burden on family and friends (56%). In contrast, life expectancy after treatment initiation (54.3%) and life expectancy without dialysis or transplantation (47%) were less frequently cited. Desire for the participation of physicians and other healthcare providers in SDM Most (70%) patients wanted their treating physician to participate actively in the SDM. Patients also expressed a desire for various healthcare professionals knowledgeable about RRT, such as nurses, clinical engineers, and transplant coordinators (71.2%) to participate in SDM. The participation of their usual physicians outside of kidney care were also desired by 23.6% of respondents, along with medical social workers (19%), home care nurses (9.5%), and care managers (7.8%). Desired timing and frequency of SDM before RRT selection The combination of timing and frequency shows that patients who desired earlier SDM initiation, such as 1–3 years before RRT initiation, opted for more frequent engagement before RRT selection, with many opting for “every visit” or “every few months” ( Figure 1A ). Conversely, patients who desired SDM within 6 months of RRT initiation chose less frequent engagement, such as “once” or “as needed.” Download figure Open in new tab Figure 1. Sankey diagrams 1A: A Sankey diagram illustrating the combination (flow) of the timing and frequency of SDM implementation before RRT selection (n = 438). The height of the individual boxes (nodes) on the vertical axis represents relative proportions, while the thickness of the links connecting the boxes for timing and frequency reflects the relative proportions of each combination. Deep blue indicates “More than 3 years before RRT”, medium blue indicates “1 to less than 3 years before RRT”, light blue indicates “6 months to less than 1 year before RRT”, and very light blue indicates” Less than 6 months before RRT”. Red indicates “Every visit,” orange indicates “Every few months,” light orange indicates “Every 6 months or more,” green indicates “As needed,” and light yellow indicates “Once.” For example, 3.2% of patients reported timing of “More than 3 years before” with a frequency of “Every visit.” In contrast, 1.1% reported timing of “6 months to less than 1 year before” with a frequency of “As needed,” and 22.8% reported timing of “Less than 6 months before” with a frequency of “Once.” 1B: A Sankey diagram illustrating the frequency of SDM implementation after RRT selection and preferences for SDM after RRT initiation (n = 440). The thickness of the links connecting the boxes for frequency of implementation and preferences after RRT initiation indicates the relative proportions of each combination. Red indicates “Every visit,” orange indicates “Every few months,” light orange indicates “Every 6 months or more,” green indicates “As needed,” and light yellow indicates “Not necessary.” Blue indicates “Want SDM,” orange indicates “No SDM,” and grey indicates “Unsure.” Desired frequency of SDM after RRT selection and preference for SDM after RRT initiation Many patients who desired regular SDM after RRT selection (categorized as “Every” or “Few months”) expressed a continued desire for SDM (“Want SDM”) following RRT initiation ( Figure 1B ). Conversely, patients with less frequent (e.g., “as needed”) or no desire for SDM after RRT selection often reported “Unsure” or expressed no desire for further engagement in SDM (“No SDM”) after RRT initiation. Factors associated with a strong patient perception that RRT selection was via SDM Several patient-level characteristics were associated with a strong perception that RRT selection was via SDM ( Table 4 ). Compared with patients with an education level of junior high school or lower, those with a high school education (prevalence ratio [PR]: 0.61, 95% CI: 0.44–0.83), those with a university or graduate school education (PR: 0.64, 95% CI: 0.42–0.95) and those in the “other” education category (PR: 0.75, 95% CI: 0.57–0.996) were less likely to perceive RRT selection as involving SDM. Patients with an annual income of less than 1,000,000 yen were less likely to perceive RRT selection as involving SDM than those with an income of over 10,000,000 yen (PR: 0.53, 95% CI: 0.32 to 0.86). Patients who had two or more outpatient visits for RRT selection were more likely to report perceived SDM than those who had no visits (PR: 1.59, 95% CI: 1.05 to 2.42). View this table: View inline View popup Table 4. Associations of perceived SDM with patients’ and facilities’ covariates† (n = 468) Facility-level characteristics also impacted perceived SDM. Patients at moderate-to-high capacity hospitals (≥400 beds) were more likely to perceive RRT selection as involving SDM than those at clinics with fewer than 20 beds (PR: 1.99, 95% CI: 1.04 to 3.78). However, patients at facilities with more than 100 RRT initiations per year were less likely to perceive RRT selection as involving SDM than those at facilities with fewer than 30 initiations (PR: 0.50, 95% CI: 0.30–0.85). The availability of specialized outpatient visits for RRT selection and the type of physician discussing RRT options with patients were not associated with perceptions of SDM. Discussion To the best of our knowledge, this is the first nationwide, multicenter survey in Japan to explore SDM perceptions and preferences for RRT selection among patients with CKD. The survey demonstrated a high percentage of patients perceiving their RRT selection process as involving SDM. It also highlighted key characteristics of the SDM process, including preferred dialogue content, timing and frequency of discussions, desired involvement of specific healthcare professionals, and system-level factors associated with SDM perceptions. The study revealed that while over 80% of patients perceived their RRT selection process as involving SDM, approximately 80% did not have a clear understanding of SDM prior to making their RRT choice. This significant gap underscores a critical issue and emphasizes the need for enhanced communication and education during routine CKD visits. The fact that most patients prioritize information about how RRT will affect their daily lives—such as limitations on daily activities and the financial burdens associated with treatment—highlights a gap between what patients seek and what healthcare providers, particularly nephrologists, typically offer. 2 , 15 Although discussing the medical aspects of different RRT modalities and prognoses is undoubtedly important, it represents only one of many concerns for patients in their daily lives. 2 In fact, for older adults with advanced CKD, maintaining independence often takes precedence over survival. 15 Therefore, the International Society for Peritoneal Dialysis’s recommendation to plan treatment in alignment with the patient’s life goals—while considering the lifestyle of the patient and family—could be applied earlier in the RRT decision-making process. 16 Although the JSDT proposals also emphasize the importance of discussing the impact of RRT on daily life as part of appropriate information provision, 17 this study suggests that the financial implications should be explicitly included as part of the standard topics for discussion. Many patients expressed a preference for the timing of SDM to coincide with when RRT became an immediate and tangible concern in their daily lives. Specifically, approximately one-third of patients preferred SDM to occur 6 months to 1 year before RRT initiation, while about 30% preferred it 1 to 3 years prior to RRT initiation. The JSDT recommends providing information about RRT when eGFR falls below 30 mL/min/1.73 m². 17 However, a U.S. study estimated the median time to ESKD from an eGFR of 30 mL/min/1.73 m² to be approximately 6 to 10 years. 18 A U.S. qualitative study highlighted a tendency among patients to focus primarily on living in the “present” rather than planning for the “future.” 2 Similarly, a U.K. qualitative study suggested that decision-making discussions may feel irrelevant to patients who do not anticipate needing to make decisions for several years. 19 These findings indicate that the timing of SDM may need to be delayed beyond the point recommended by the JSDT, aligning instead with a timeframe that feels more immediately relevant to patients. The high priority that patients place on discussing the burden on family and friends may reflect the concept of relational autonomy prevalent in Asia, including Japan. 4 This emphasis not only highlights a cultural context where family members are often actively involved in medical decision-making, but also underscores the patients’ own prioritization of burden on family. This prioritization stems from deeply rooted values of family obligations, solidarity, and harmony. 20 However, there are concerns about complex situations where family involvement may inadvertently lead to decisions that overlook the patient’s true wishes owing to implicit pressure. 3 , 8 To address this, as outlined in the JSDT proposal for SDM, it is essential to gather sufficient information about the patient’s relationship with their family members. 17 This ensures a deeper understanding of whether the patient’s desire not to burden their family genuinely reflects their own intentions or arises from external pressures. Several factors may explain why many patients preferred to receive repeated explanations both before and after RRT initiation. First, decision-making in RRT is inherently a multi-stage process. 19 For instance, patients must navigate a series of decisions, starting with whether to undergo RRT, followed by selecting a modality (hemodialysis or peritoneal dialysis), and, if hemodialysis is chosen, determining the type of vascular access (arteriovenous fistula, graft, or catheter). Expecting patients to make these complex decisions in a single outpatient visit is unrealistic. Second, patients may find it difficult to engage in meaningful dialogue about RRT options because emotional burdens 4 and hopelessness when confronting the realities of RRT. 4 , 21 The desire for repeated explanations may reflect fluctuating emotions patients experience even after reaching a decision. Third, presenting all the information about RRT in a single, condensed session can overwhelm patients. An Australian qualitative study highlights the importance of iterative discussions, as emphasized by a nephrologist who recognized the need to clarify preferences and confirm decisions over time, while avoiding patient overload. 3 Finally, it is worth highlighting the association between multiple outpatient visits for RRT selection—featuring multidisciplinary healthcare provider involvement, including nursing staff, and consultations lasting a minimum of 30 min—and enhanced perceptions of SDM. This finding emphasizes the importance of a system-level approach to SDM, incorporating the contributions of various professionals in addition to physicians, particularly in time-constrained settings. 4 , 8 One possible explanation for the observed association between moderate-to-high-capacity hospitals and greater rates of SDM perception may lie in their ability to facilitate more diverse multiprofessional involvement in the RRT decision-making process. For instance, in the multiple outpatient visits for RRT selection, nursing staff can provide repeated explanations of RRT options and engage with patients to explore their preferences, values, and needs. 8 In the moderate-to-high-capacity hospitals, medical social workers can assist in preparing for the SDM process by offering guidance on financial support and access to social services. 8 The observation that patients perceive SDM more positively during multiple outpatient visits, as opposed to a single visit, aligns with findings in the general population, where more frequent visits are associated with a higher likelihood of recognizing person-centered interactions that include SDM elements. 22 Additionally, given that patients often place greater trust in their usual non-nephrologist physicians with whom they have established longer-term relationships, 23 incorporating these professionals’ perspectives into RRT selection may prove valuable. 2 Care continuity provided by multiprofessional healthcare teams, alongside coordination with patients’ usual non-kidney physicians, should be prioritized to facilitate optimal RRT selection decisions. 8 Additionally, reimbursement policies should account for these practical and patient-centered care approaches to ensure their sustainability and effectiveness. The strength of this study lies in its multi-center design, encompassing 49 medical facilities with small to high bed capacities across Japan, thereby ensuring broad generalizability within the Japanese context. This design also enabled the assessment of the influence of facility-level structural variations on SDM perception. However, some limitations must be acknowledged. First, the participating facilities may have been skewed toward moderate-to high-bed-capacity hospitals, as a relatively large proportion of included facilities were those with well-qualified nephrologists known to the authors. This selection bias may partially explain the high percentage of patients who perceived their RRT selection process as involving SDM. Such facilities often have specialized outpatient services for RRT selection and provide opportunities for multidisciplinary healthcare providers to participate, creating ideal conditions for RRT-related SDM. Second, we did not examine the number of eligible patients with CKD who declined to participate in the study. Based on the number of RRT initiations per quarter at each facility and the duration of the survey, we estimate that approximately 1,850 RRTs were initiated across the participating facilities. Although this total includes patients who opted out or were ineligible owing to emergent RRT initiation or conditions like dementia, it is noteworthy that patients with CKD who participated in the study represented roughly 26% of all RRT initiations. Third, the study excluded conservative kidney management (CKM) from its primary focus. For frail patients or those at high risk of mortality, CKM may provide a better quality of life than RRT, 15 , 17 underscoring the need for further research in this area. Fourth, SDM perception was assessed via patient self-report rather than actual outpatient records. Thus, even if healthcare providers presented treatment options, explained their characteristics, and elicited patients’ preferences and values, patients might not recall these interactions accurately. However, as our study targeted patients with CKD who had selected an RRT modality but had not yet commenced treatment, we anticipate that most patients could recall the selection process to a reasonable extent. In summary, this nationwide study revealed that most patients with CKD in Japan perceived their RRT selection process as involving SDM. Patients prioritized discussions about the effects of RRT on daily life, financial burdens, and the impact on family members over medical aspects. They also expressed a preference for involving their usual non-nephrology physician and a multidisciplinary healthcare team in the RRT decision-making process. Additionally, patients preferred that SDM take place when RRT initiation became an imminent concern, occurring over multiple sessions rather than a single visit. Notably, patients who attended multiple outpatient visits for RRT selection, with participation from nurses and with sufficient time being allocated for discussion, were more likely to perceive the process as SDM. Data Availability The data underlying this article will be shared on reasonable request to the corresponding author. Disclosure T. Sofue has received payment for speaking from Astrazeneca K.K. and Astellas Pharma Inc., Kyowa Kirin Co., Ltd. T. Toida has received consulting fees from Astellas Pharma Inc. and payment for speaking and educational events from Torii Pharmaceutical Co., Ltd., Ono Pharmaceutical Co., Ltd., Kyowa Kirin Co., Ltd., AstraZeneca K.K., Nobelpharma Co., Ltd., and Novo Nordisk Pharma Ltd. T. Suzuki has received payment for speaking and educational events from Astellas Pharma Inc, AstraZeneca K.K, Vantive Japan, Daiichi Sankyo Co.,Ltd., Janssen Pharmaceutical K.K, Kaneka Medix Corp, Kissei Pharmaceutical Co.,Ltd., Kowa Co.,Ltd., Kyowa Kirin Co.,Ltd, Mochida Pharmaceutical Co.,Ltd., Nobelpharma Co.,Ltd, Novartis Pharma K.K., Novo Nordisk Pharma.,Ltd., Ono Pharmaceutical Co.,Ltd., Otsuka Pharmaceutical, Terumo Corp, and Torii Pharmaceutical Co.,Ltd. HT has received consulting fees from Aplause Pharma, and payment for speaking from Kyowa Kirin Co., Ltd., Mochida Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Corporation, Terumo Corporation, JMS Co., Ltd., Vantive Japan, Torii Pharmaceutical Co., Ltd., Fuji Systems Corporation, and Sanwa Kagaku Kenkyujo Co., Ltd. RI has received payment for speaking and educational events from Vantive Japan. S. Shibata received personal fees and/or research funding from AstraZeneca, Bayer, Daiichi-Sankyo, Fuji Yakuhin, Kyowa-Kirin, Mochida, and Torii. NK has received consulting fees from GlaxoSmithKline K.K., and payment for speaking and educational events from Eisai Co., Ltd., Taisho Pharmaceutical Co., Ltd., Kyowa Kirin Co., Ltd., GlaxoSmithKline K.K., Takeda Pharmaceutical Co., Ltd., Kissei Pharmaceutical Co., Ltd., and Baxter Corporation. Statement The author(s) used ChatGPT during the preparation of this manuscript to enhance clarity and grammar. All content remains original. Following the use of this tool, the author(s) thoroughly reviewed and edited the material and assume full responsibility for the final content of the publication. Author contributions Y.S. and N.K. conceived and designed the study. N.K. performed the statistical analyses. N.K. developed the figures and tables. Y.S. and N.K. drafted and revised the paper. All authors except for T. Toida and N.K. acquired data. All authors interpreted the data, provided intellectual content, and approved the final version of the manuscript. Data sharing statement The data underlying this article will be shared on reasonable request to the corresponding author. Supplementary Material Supplementary Figure S1; Supplementary Items 1–4 Acknowledgements This study was supported by JSPS KAKENHI (grant numbers: JP19KT0021, JP21K10314, and JP22K19690). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Footnotes ↵ ⍰ The other members of the PREPARES study group are listed in the Supplementary Item S1. Support This study was supported by JSPS KAKENHI (grant numbers: JP19KT0021, JP21K10314, and JP22K19690). Reference 1. ↵ Whitney SN , McGuire AL , McCullough LB . A typology of shared decision making, informed consent, and simple consent . Ann Intern Med . 2003 ; 140 ( 1 ): 54 – 59 . doi: 10.7326/0003-4819-140-1-200401060-00012 OpenUrl CrossRef Web of Science 2. ↵ House TR , Wightman A , Rosenberg AR , et al. Challenges to Shared Decision Making About Treatment of Advanced CKD: A Qualitative Study of Patients and Clinicians . Am J Kidney Dis . 2022 ; 79 ( 5 ): 657 – 666 .e1. doi: 10.1053/j.ajkd.2021.08.021 OpenUrl CrossRef PubMed 3. ↵ Dahm MR , Raine SE , Slade D , et al. Older patients and dialysis shared decision-making. Insights from an ethnographic discourse analysis of interviews and clinical interactions . Patient Educ Couns . 2024 ; 122 ( 108124 ): 108124 . doi: 10.1016/j.pec.2023.108124 OpenUrl CrossRef PubMed 4. ↵ Yu X , Nakayama M , Wu MS , et al. Shared Decision-Making for a Dialysis Modality . Kidney Int Rep . 2022 ; 7 ( 1 ): 15 – 27 . doi: 10.1016/j.ekir.2021.10.019 OpenUrl CrossRef PubMed 5. ↵ Sakurada T , Koitabashi K , Murasawa M , et al. Effects of one-hour discussion on the choice of dialysis modality at the outpatient clinic: A retrospective cohort study using propensity score matching . Ther Apher Dial . 2023 ; 27 ( 3 ): 442 – 451 . doi: 10.1111/1744-9987.13941 OpenUrl CrossRef PubMed 6. ↵ Kohatsu K , Kojima S , Shibagaki Y , et al. Shared decision-making in selecting modality of renal replacement therapy confers better patient prognosis after the initiation of dialysis . Ther Apher Dial . 2025 ; 29 ( 1 ): 34 – 41 doi: 10.1111/1744-9987.14192 OpenUrl CrossRef PubMed 7. ↵ Ladin K , Lin N , Hahn E , et al. Engagement in decision-making and patient satisfaction: a qualitative study of older patients’ perceptions of dialysis initiation and modality decisions . Nephrol Dial Transplant . 2017 ; 32 ( 8 ): 1394 – 1401 . doi: 10.1093/ndt/gfw307 OpenUrl CrossRef PubMed 8. ↵ Zagt AC , Bos N , Bakker M , et al. A scoping review into the explanations for differences in the degrees of shared decision making experienced by patients . Patient Educ Couns . 2024 ; 118 ( 108030 ): 108030 . doi: 10.1016/j.pec.2023.108030 OpenUrl CrossRef PubMed 9. ↵ Sekimoto M , Asai A , Ohnishi M , et al. Patients’ preferences for involvement in treatment decision making in Japan . BMC Fam Pract . 2004 ; 5 ( 1 ): 1 . doi: 10.1186/1471-2296-5-1 OpenUrl CrossRef PubMed 10. ↵ Rockwood K , Theou O . Using the Clinical Frailty Scale in Allocating Scarce Health Care Resources . Can Geriatr J . 2020 ; 23 ( 3 ): 210 – 215 . doi: 10.5770/cgj.23.463 OpenUrl CrossRef PubMed 11. ↵ The Japan Geriatrics Society . Clinical Frailty Scale - Japanese . November 2 , 2024 . Accessed August 23, 2024 . https://www.jpn-geriat-soc.or.jp/tool/pdf/tool_14.pdf 12. ↵ Lamer A , Laurent G , Pelayo S , et al. Exploring patient path through Sankey diagram: A proof of concept . Stud Health Technol Inform . 2020 ; 270 : 218 – 222 . doi: 10.3233/SHTI200154 OpenUrl CrossRef PubMed 13. ↵ Zou G . A modified poisson regression approach to prospective studies with binary data . Am J Epidemiol . 2004 ; 159 ( 7 ): 702 – 706 . doi: 10.1093/aje/kwh090 OpenUrl CrossRef PubMed Web of Science 14. ↵ Hanafusa N , Abe M , Joki N , et al. 2022 Annual Dialysis Data Report, JSDT Renal Data Registry . J Jpn Soc Dial Ther . 2023 ; 56 ( 12 ): 473 – 536 (In Japanese except for abstract). doi: 10.4009/jsdt.56.473 OpenUrl CrossRef 15. ↵ Ramer SJ , McCall NN , Robinson-Cohen C , et al. Health outcome priorities of older adults with advanced CKD and concordance with their nephrology providers’ perceptions . J Am Soc Nephrol . 2018 ; 29 ( 12 ): 2870 – 2878 . doi: 10.1681/ASN.2018060657 OpenUrl Abstract / FREE Full Text 16. ↵ Brown EA , Blake PG , Boudville N , et al. International Society for Peritoneal Dialysis practice recommendations: Prescribing high-quality goal-directed peritoneal dialysis . Perit Dial Int . 2020 ; 40 ( 3 ): 244 – 253 . doi: 10.1177/0896860819895364 OpenUrl CrossRef PubMed 17. ↵ Okada K , Tsuchiya K , Sakai K , et al. Shared decision making for the initiation and continuation of dialysis: a proposal from the Japanese Society for Dialysis Therapy . Ren Replace Ther . 2021 ; 7 ( 1 ). doi: 10.1186/s41100-021-00365-5 OpenUrl CrossRef 18. ↵ Grams ME , Li L , Greene TH , et al. Estimating time to ESRD using kidney failure risk equations: results from the African American Study of Kidney Disease and Hypertension (AASK) . Am J Kidney Dis . 2015 ; 65 ( 3 ): 394 – 402 . doi: 10.1053/j.ajkd.2014.07.026 OpenUrl CrossRef PubMed 19. ↵ Joseph-Williams N , Williams D , Wood F , et al. A descriptive model of shared decision making derived from routine implementation in clinical practice (’Implement-SDM’): Qualitative study . Patient Educ Couns . 2019 ; 102 ( 10 ): 1774 – 1785 . doi: 10.1016/j.pec.2019.07.016 OpenUrl CrossRef PubMed 20. ↵ Alden DL , Friend J , Lee PY , et al. Who Decides: Me or We? Family Involvement in Medical Decision Making in Eastern and Western Countries . Med Decis Making . 2018 ; 38 ( 1 ): 14 – 25 . doi: 10.1177/0272989X17715628 OpenUrl CrossRef PubMed 21. ↵ Kurita N , Wakita T , Ishibashi Y , et al. Association between health-related hope and adherence to prescribed treatment in CKD patients: multicenter cross-sectional study . BMC Nephrol . 2020 ; 21 ( 1 ): 453 . doi: 10.1186/s12882-020-02120-0 OpenUrl CrossRef PubMed 22. ↵ Okamura M , Fujimori M , Otsuki A , et al. Patients’ perceptions of patient-centered communication with healthcare providers and associated factors in Japan - The INFORM Study 2020 . Patient Educ Couns . 2024 ; 122 ( 108170 ): 108170 . doi: 10.1016/j.pec.2024.108170 OpenUrl CrossRef PubMed 23. ↵ Barrett TM , Green JA , Greer RC , et al. Advanced CKD Care and Decision Making: Which Health Care Professionals Do Patients Rely on for CKD Treatment and Advice? Kidney Medicine . 2020 ; 2 ( 5 ): 532 – 542 .e1. doi: 10.1016/j.xkme.2020.05.008 OpenUrl CrossRef PubMed View the discussion thread. Back to top Previous Next Posted January 12, 2025. Download PDF Supplementary Material Data/Code Email Thank you for your interest in spreading the word about medRxiv. NOTE: Your email address is requested solely to identify you as the sender of this article. Your Email * Your Name * Send To * Enter multiple addresses on separate lines or separate them with commas. You are going to email the following Shared Decision-Making in Renal Replacement Therapy Selection: Patient Perceptions, Preferences, and Influencing Factors in a Nationwide Cross-Sectional Study in Japan Message Subject (Your Name) has forwarded a page to you from medRxiv Message Body (Your Name) thought you would like to see this page from the medRxiv website. 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Share Shared Decision-Making in Renal Replacement Therapy Selection: Patient Perceptions, Preferences, and Influencing Factors in a Nationwide Cross-Sectional Study in Japan Yugo Shibagaki , Tadashi Sofue , Hiroo Kawarazaki , Tatsunori Toida , Tomo Suzuki , Hiroki Nishiwaki , Kenichiro Asano , Hiroyuki Terawaki , Takafumi Ito , Hideaki Oka , Kei Nagai , Minoru Murakami , Kojiro Nagai , Daisuke Komukai , Takayuki Adachi , Satoshi Furukata , Takaaki Tsutsui , Kiichiro Fujisaki , Seita Sugitani , Hideaki Shimizu , Tomoya Nishino , Hiroaki Asada , Hideki Shimizu , Tatsuo Tsukamoto , Izaya Nakaya , Yosuke Yamada , Ryohei Inanaga , Shohei Yamada , Shohei Nakanishi , Atsuhiro Maeda , Mari Yamamoto , Shuma Hirashio , Takeshi Okamoto , Takayuki Nakamura , Ken-ichi Miyoshi , Hiroshi Kado , Susumu Toda , Shigeru Shibata , Keiko Nishi , Makoto Yamamoto , Tsukasa Naganuma , Ryo Zamami , Masahide Furusho , Hitoshi Miyasato , Yukihiro Tamura , Yoshihiko Raita , Chisato Fukuhara , Keita Uehara , Kosuke Inoue , Yasuhiro Taki , Nobuyuki Nakano , Noriaki Kurita , the PREPARES Study Group medRxiv 2025.01.11.25320378; doi: https://doi.org/10.1101/2025.01.11.25320378 Share This Article: Copy Citation Tools Shared Decision-Making in Renal Replacement Therapy Selection: Patient Perceptions, Preferences, and Influencing Factors in a Nationwide Cross-Sectional Study in Japan Yugo Shibagaki , Tadashi Sofue , Hiroo Kawarazaki , Tatsunori Toida , Tomo Suzuki , Hiroki Nishiwaki , Kenichiro Asano , Hiroyuki Terawaki , Takafumi Ito , Hideaki Oka , Kei Nagai , Minoru Murakami , Kojiro Nagai , Daisuke Komukai , Takayuki Adachi , Satoshi Furukata , Takaaki Tsutsui , Kiichiro Fujisaki , Seita Sugitani , Hideaki Shimizu , Tomoya Nishino , Hiroaki Asada , Hideki Shimizu , Tatsuo Tsukamoto , Izaya Nakaya , Yosuke Yamada , Ryohei Inanaga , Shohei Yamada , Shohei Nakanishi , Atsuhiro Maeda , Mari Yamamoto , Shuma Hirashio , Takeshi Okamoto , Takayuki Nakamura , Ken-ichi Miyoshi , Hiroshi Kado , Susumu Toda , Shigeru Shibata , Keiko Nishi , Makoto Yamamoto , Tsukasa Naganuma , Ryo Zamami , Masahide Furusho , Hitoshi Miyasato , Yukihiro Tamura , Yoshihiko Raita , Chisato Fukuhara , Keita Uehara , Kosuke Inoue , Yasuhiro Taki , Nobuyuki Nakano , Noriaki Kurita , the PREPARES Study Group medRxiv 2025.01.11.25320378; doi: https://doi.org/10.1101/2025.01.11.25320378 Citation Manager Formats BibTeX Bookends EasyBib EndNote (tagged) EndNote 8 (xml) Medlars Mendeley Papers RefWorks Tagged Ref Manager RIS Zotero Tweet Widget Facebook Like Google Plus One Subject Area Nephrology Subject Areas All Articles Addiction Medicine (568) Allergy and Immunology (863) Anesthesia (299) Cardiovascular Medicine (4423) Dentistry and Oral Medicine (443) Dermatology (382) Emergency Medicine (607) Endocrinology (including Diabetes Mellitus and Metabolic Disease) (1507) Epidemiology (15219) Forensic Medicine (30) Gastroenterology (1123) Genetic and Genomic Medicine (6587) Geriatric Medicine (667) Health Economics (997) Health Informatics (4524) Health Policy (1368) Health Systems and Quality Improvement (1612) Hematology (540) HIV/AIDS (1264) Infectious Diseases (except HIV/AIDS) (15910) Intensive Care and Critical Care Medicine (1103) Medical Education (623) Medical Ethics (145) Nephrology (667) Neurology (6588) Nursing (345) Nutrition (998) Obstetrics and Gynecology (1143) Occupational and Environmental Health (956) Oncology (3331) Ophthalmology (970) Orthopedics (369) Otolaryngology (420) Pain Medicine (435) Palliative Medicine (129) Pathology (663) Pediatrics (1690) Pharmacology and Therapeutics (691) Primary Care Research (710) Psychiatry and Clinical Psychology (5438) Public and Global Health (9218) Radiology and Imaging (2195) Rehabilitation Medicine and Physical Therapy (1369) Respiratory Medicine (1195) Rheumatology (593) Sexual and Reproductive Health (709) Sports Medicine (529) Surgery (709) Toxicology (99) Transplantation (289) Urology (265) (function(){function c(){var b=a.contentDocument||a.contentWindow.document;if(b){var d=b.createElement('script');d.innerHTML="window.__CF$cv$params={r:'9ff8355a6be5aa64',t:'MTc3OTQxNTAyOA=='};var a=document.createElement('script');a.src='/cdn-cgi/challenge-platform/scripts/jsd/main.js';document.getElementsByTagName('head')[0].appendChild(a);";b.getElementsByTagName('head')[0].appendChild(d)}}if(document.body){var a=document.createElement('iframe');a.height=1;a.width=1;a.style.position='absolute';a.style.top=0;a.style.left=0;a.style.border='none';a.style.visibility='hidden';document.body.appendChild(a);if('loading'!==document.readyState)c();else if(window.addEventListener)document.addEventListener('DOMContentLoaded',c);else{var e=document.onreadystatechange||function(){};document.onreadystatechange=function(b){e(b);'loading'!==document.readyState&&(document.onreadystatechange=e,c())}}}})();