Mongkolrattanakul Pannawat, Chienwichai Kittiphan
Division of Nephrology, Department of Internal Medicine, Phanatnikhom Hospital, Chonburi, Thailand.
Division of Nephrology, Department of Internal Medicine, Hatyai Hospital, Songkhla, 90110, Thailand.
BMC Nephrol. 2025 May 2;26(1):224. doi: 10.1186/s12882-025-04144-w.
To evaluate the effectiveness of a Shared Decision-Making (SDM) program in reducing unplanned dialysis among patients with advanced chronic kidney disease (CKD) and to identify factors predictive of unplanned dialysis.
This retrospective cohort study was conducted at Phanatnikhom Hospital in Chonburi, Thailand, from October 2021 to September 2023. Patients aged 18 years and older with CKD stages 4 and 5 who were receiving renal replacement therapy (RRT) were included. Starting in October 2022, the Shared Decision-Making (SDM) program was implemented as the standard of care. Baseline demographic data, dialysis modalities, and the incidence of unplanned dialysis were collected. Unplanned dialysis was defined as dialysis initiated through a temporary catheter or within a short time frame after the initial dialysis decision.
Among 111 patients, 66 received SDM, and 45 received usual care. The incidence of unplanned dialysis was significantly lower in the SDM group compared to the usual care group (33.3% vs. 66.7%, p < 0.001). Multivariate analysis indicated that participation in the SDM program (OR = 0.19, p = 0.001), peritoneal dialysis (OR = 0.26, p = 0.032), and higher serum albumin at the initiation of dialysis (OR = 0.33, p = 0.014) were protective factors against unplanned dialysis.
The SDM program effectively reduces unplanned dialysis in patients with advanced CKD by aligning medical decisions with patient preferences and priorities. Peritoneal dialysis and higher serum albumin levels at dialysis initiation are also associated with lower rates of unplanned dialysis.
评估共享决策（SDM）项目在减少晚期慢性肾脏病（CKD）患者非计划透析方面的有效性，并确定非计划透析的预测因素。
这项回顾性队列研究于2021年10月至2023年9月在泰国春武里府的帕纳蒂孔医院进行。纳入年龄在18岁及以上、处于CKD 4期和5期且正在接受肾脏替代治疗（RRT）的患者。从2022年10月开始，实施共享决策（SDM）项目作为标准治疗方案。收集基线人口统计学数据、透析方式以及非计划透析的发生率。非计划透析定义为通过临时导管开始的透析或在初始透析决策后的短时间内开始的透析。
在111例患者中，66例接受了SDM，45例接受了常规治疗。与常规治疗组相比，SDM组的非计划透析发生率显著更低（33.3%对66.7%，p<0.001）。多因素分析表明，参与SDM项目（比值比[OR]=0.19，p=0.001）、腹膜透析（OR=0.26，p=0.032）以及透析开始时较高的血清白蛋白水平（OR=0.33，p=0.014）是预防非计划透析的保护因素。
SDM项目通过使医疗决策与患者的偏好和优先事项相一致，有效降低了晚期CKD患者的非计划透析率。腹膜透析以及透析开始时较高的血清白蛋白水平也与较低的非计划透析率相关。
