Understanding the kidney replacement therapy decision-making process

Sep 28, 2026

Uploaded by ahduag

Late-stage chronic kidney disease (CKD) patients face life-changing decisions about kidney replacement therapy (KRT) options, yet the best way to support those decisions and the optimal timing of support remain unclear. This primarily qualitative cross-sectional cohort study used journey mapping to identify interventions that improve KRT decision-making, assess when they should occur, and examine whether patterns differ across CKD groups. Findings show similar decision-making journeys across groups and highlight key intervention approaches for future prospective testing.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages9

Reading Time23 min

AccessFree to download

Abstract

Background

Methods

Study design and participants

Results

Conclusions

Introduction

KRT options and decision support tools

Prakash et al. BMC Nephrology (2026) 27:3 [https://doi.org/10.1186/s12882-025-04638-7](https://doi.org/10.1186/s12882-025-04638-7) BMC Nephrology RESEARCH Open Access Understanding the kidney replacement therapy decision-making process Suma Prakash 1*, Spoorthy Vangala2, Kauser Razvi3, Matthew H. Taylor 1, Erika Drury 1, Marcus D’Alfonso4, Igor Oliveira2, Thu H. Le 1,5, Peter Veazie2 and Scott McIntosh2 Abstract Background Patients with late-stage chronic kidney disease (CKD) engage in life changing kidney replacement therapy (KRT) option(s) decision-making. This study aimed to do the following using journey mapping: determine new interventions to improve KRT decision-making and optimal timing of these interventions and to assess differences across CKD groups with regards to KRT decision-making. Methods This was a primarily qualitative cross-sectional cohort study of adults in one of the following 5 CKD groups: CKD 5 decided on KRT option, CKD 4 decided, CKD 4&5 undecided, post-transplant CKD 4&5, and CKD 3b-5 initially, who start unplanned dialysis in hospital requiring outpatient dialysis. CKD patients enrolled to participate in individual journey mapping sessions. Nephrology providers participated in focus groups. All participants completed demographic surveys. Individual journey maps were aggregated by process steps and emotional journeys by CKD group. Theme coding for journey maps and focus groups was performed by two study team members. A patient focus group was conducted for review of group journey map accuracy. Semi-structured interview guides were created for journey maps and focus groups. Descriptive quantitative statics were performed. Results Forty-two patients participated in journey mapping; ten in the CKD 5 decided group and eight each in the other four groups. There were eleven provider participants from seven centers. Identified interventions for improvement were: assistance with shock/grief after the nephrologist recommends making a KRT decision, talking with peers to obtain patient perspectives on living with different KRT options, learning the kidney disease progression risk at the 2nd or 3rd nephrology visit and learning about all KRT options regardless of candidacy. Themes that emerged from provider focus groups were similar to those obtained with patient journey mapping. There were no significant differences in demographic trends in the suggested interventions ascertained for improving the KRT decision-making process. Conclusions KRT decision-making journeys were similar across groups; thus a tailored approach by CKD group is not warranted. Key intervention approaches to improve KRT decision-making experience were identified for testing in future prospective studies. Keywords Kidney replacement therapy, Medical decision-making, Journey mapping *Correspondence: Suma Prakash [Suma_Prakash@urmc. rochester.edu](Suma_Prakash@urmc. rochester.edu); [suma74@gmail.com](suma74@gmail.com) 1Department of Medicine, Division of Nephrology, University of Rochester Medical Center, 601 Elmwood Avenue Box 675, Rochester, NY 14642, USA 2Department of Public Health Sciences , University of Rochester Medical Center, 265 Crittenden Blvd. CU420644, Rochester, NY 14627, USA 3Strategic Urban Solutions Inc, 2900 Jay Ave, Cleveland, OH 44113, USA 4Department of Urology, University of Rochester Medical Center, 158 Sawgrass Drive, Second Floor Rochester, Rochester, NY 14620, USA 5Department of Medicine, University of California Irvine, 1001 Health Sciences Rd, Irvine, CA 92617, USA © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed mater

FAQs

What was the main purpose of this study?

To determine interventions that improve KRT decision-making, identify when those interventions should be introduced, and assess differences across CKD groups in decision-making processes.

How did the study evaluate the KRT decision-making process?

The study used journey mapping sessions with CKD patients and focus groups with nephrology providers, then coded themes from the maps and discussions.

Did the study find differences in decision-making journeys across CKD groups?

No significant differences were found in the demographic trends related to suggested interventions, and KRT decision-making journeys were reported as similar across groups.

Sep 28, 2026

Uploaded by ahduag