Factors associated with decision-making regarding renal replacement therapy among patients with stage 4 and 5 chronic kidney disease: A mixed-methods systematic review
Keywords:
mixed-methods systematic review, renal replacement therapy, chronic kidney diseaseAbstract
Decision-making regarding renal replacement therapy (RRT) for patients with stage 4 and 5 chronic kidney disease (CKD) is a complex process that significantly impacts long-term quality of life. Multiple factors influence this decision at the individual, family, and healthcare system levels. However, the synthesis of knowledge regarding this topic remains limited at present. This study aimed to systematically review and synthesize evidence on the factors influencing RRT decision-making among patients with stage 4 and 5 CKD using a mixed-methods systematic review approach. Qualitative and quantitative studies published between 2014 and 2024 were systematically searched across six databases: CINAHL, Cochrane, ProQuest, PubMed, Scopus, and ThaiJo. A total of 8,411 articles were identified, and 14 studies were finally included after screening. These comprised 11 qualitative studies, one quasi-experimental study, and two descriptive quantitative studies. The quality of all included studies was assessed using the Mixed Methods Appraisal Tool (MMAT), Version 2018, and all met the predetermined quality criteria. Data were analyzed using parallel-results convergent design, quantitative and qualitative data analyses were conducted separately before the results from both sets of data were integrated to address the research questions.
The results identified four major categories of related factors: (1) individual factors, such as age, comorbidities, beliefs, and personal values; (2) access to and understanding of health information, including information complexity and language barriers; (3) support from family and healthcare professionals, which plays a key role in information provision and decision-making confidence; and (4) healthcare system and policy factors, such as facility availability and patient benefit entitlements.
This study's findings reflect that decision-making processes ought to be supported by a holistic healthcare framework that acknowledges patient beliefs, cultural values, and challenges related to information complexity or linguistic limitations. Additionally, it highlights the importance of engaging family members and healthcare professionals in shared decision-making processes. The knowledge synthesized from this study can inform the development of patient-centered care models and policies that promote informed and context-appropriate treatment decisions for each individual.
References
GBD Chronic Kidney Disease Collaboration. Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2020;395(10225):709–33. Available from: https://doi.org/10.1016/S0140-6736(20)30045-3
Liyanage T, Ninomiya T, Jha V, Neal B, Patrice HM, Okpechi I, et al. Worldwide access to treatment for end-stage kidney disease: a systematic review. Lancet 2015; 385(9981):1975–82. Available from: https://doi.org/10.1016/S0140-6736(14)61601-9
Department of Disease Control, Risk Communication and Health Behavior Development Bureau. The department of disease control campaigns for world kidney day: take care of your kidneys, be mindful of your health, kidney disease, emphasizing that diabetic patients should undergo physical examinations to screen for kidney disease [Internet]. Nonthaburi: Department of Disease Control; 2025 [cited 2025 Jun 14]. Available from: https://ddc.moph.go.th/brc/news.php?deptcode=brc&news=50932 (in Thai)
Thai Kidney Disease Prevention Subcommittee, Nephrology Society of Thailand. Clinical practice guideline for the care of patients with chronic kidney disease prior to renal replacement therapy, B.E. 2565 (revised ed.). Bangkok: Srimuang Printing; 2022.
Webster AC, Nagler EV, Morton RL, Masson P. Chronic kidney disease. Lancet.2017;389(10075):1238–52. Available from: https://doi.org/10.1016/S0140-6736(16)32064-5
Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int 2024;105(4 Suppl):S117–314. Available from: https://doi.org/10.1016/j.kint.2023.10.018
Chen TK, Knicely DH, Grams ME. Chronic kidney disease diagnosis and management: a review. JAMA 2019;322(13):1294–304. Available from: https://doi.org/10.1001/jama.2019.14745
Monaro S, Stewart G, Gullick J. A “lost life”: coming to terms with haemodialysis. J Clin Nurs 2014;23(21–22):3262–73. Available from: https://doi.org/10.1111/jocn.12577
Bossola M, Hedayati SS, Brys ADH, Gregg LP. Fatigue in patients receiving maintenance hemodialysis: a review. Am J Kidney Dis 2023;82(4):464–80. Available from: https://doi.org/10.1053/j.ajkd.2023.02.008
Fisher M, Golestaneh L, Allon M, Abreo K, Mokrzycki MH. Prevention of bloodstream infections in patients undergoing hemodialysis. Clin J Am Soc Nephrol 2020;15(1):132–51. Available from: https://doi.org/10.2215/CJN.06820619
Cho Y, Chow KM, Li PKT, Runnegar N, Johnson DW. Peritoneal dialysis-related infections. Clin J Am Soc Nephrol 2024;19(5):641–9. Available from: https://doi.org/10.2215/CJN.0000000000000280
Lai YL, Neo HLM, Vathsala A, Griva K. Comparing emotional adjustment of living-donor and deceased-donor kidney transplant patients. Transplant Direct 2020;6(2):e529. Available from: https://doi.org/10.1097/TXD.0000000000000956
Li Y, Zhu B, Shen J, Miao L. Depression in maintenance hemodialysis patients: what do we need to know? Heliyon 2023;9(9):e19383. Available from: https://doi.org/10.1016/j.heliyon.2023.e19383
Imamah NF, Lin HR. Palliative care in patients with end-stage renal disease: a meta-synthesis. Int J Environ Res Public Health 2021;18(20):10651. Available from: https://doi.org/10.3390/ijerph182010651
National Health Security Office. Guidelines for the implementation of the renal replacement therapy system [Internet]. Bangkok: NHSO; 2023 [cited 2025 Jun 14]. Available from: https://www.nhso.go.th/th/communicate-th/thnewsforperson/2025-04-17-08-06-55
Ghonimi TA, Alkadi MM, Abdellatif MT, Ezzat H, Fouda TA, Elesnawi MA, et al. Risk factors for unplanned initiation of dialysis in patients with advanced chronic kidney disease: a retrospective cohort study. Saudi J Kidney Dis Transpl 2023;34(2):283–90.
Engels N, de Graav GN, van der Nat P, van den Dorpel M, Stiggelbout AM, Bos WJ. Shared decision-making in advanced kidney disease: a scoping review. BMJ Open 2022;12(9):e055248. Available from: https://doi.org/10.1136/bmjopen-2021-055248
Hsiao SM, Kuo MC, Hsiao PN, Moi SH, Chiu YW, Wang SL, et al. Shared decision-making for renal replacement treatment and illness perception in patients with advanced chronic kidney disease. BMC Med Inform Decis Mak 2023;23(1):159. Available from: https://doi.org/10.1186/s12911-023-02261-w
Shi Y, Li W, Duan F, Pu S, Peng H, Ha M, et al. Factors promoting shared decision-making in renal replacement therapy for patients with end-stage kidney disease: systematic review and qualitative meta-synthesis. Int Urol Nephrol 2022;54(3):553–74. Available from: https://doi.org/10.1007/s11255-021-02913-8
Hong QN, Pluye P, Bujold M, Wassef M. Convergent and sequential synthesis designs: implications for conducting and reporting systematic reviews of qualitative and quantitative evidence. Syst Rev 2017;6(1):61. Available from: https://doi.org/10.1186/s13643-017-0454-2
Stern C, Lizarondo L, Carrier J, Godfrey C, Rieger K, Salmond S, et al. Methodological guidance for the conduct of mixed methods systematic reviews. JBI Evid Synth 2020;18(10):2108–18. Available from: https://doi.org/10.11124/JBISRIR-D-19-00169
Hong QN, Pluye P, Fàbregues S, Bartlett G, Boardman F, Cargo M, et al. Mixed methods appraisal tool (MMAT), version 2018. Ottawa: Canadian Intellectual Property Office; 2018.
Muscat DM, Kanagaratnam R, Shepherd HL, Sud K, McCaffery K, Webster A. Beyond dialysis decisions: a qualitative exploration of decision-making among culturally and linguistically diverse adults with chronic kidney disease on haemodialysis. BMC Nephrol 2018;19(1):339. Available from: https://doi.org/10.1186/s12882-018-1131-y
Eneanya ND, Maddux DW, Reviriego-Mendoza MM, Larkin JW, Usvyat LA, van der Sande FM, et al. Longitudinal patterns of health-related quality of life and dialysis modality: a national cohort study. BMC Nephrol 2019;20(1):7. Available from: https://doi.org/10.1186/s12882-018-1198-5
Boateng EA, East L, Evans C. Decision-making experiences of patients with end-stage kidney disease regarding treatment in Ghana: a qualitative study. BMC Nephrol 2018;19(1):371. Available from: https://doi.org/10.1186/s12882-018-1175-z
Velez-Bermudez M, Adamowicz JL, Askelson NM, Lutgendorf SK, Fraer M, Christensen AJ. Disparities in dialysis modality decision-making using a social-ecological lens: a qualitative approach. BMC Nephrol 2022;23(1):276. Available from: https://doi.org/10.1186/s12882-022-02905-5
Han E, Haldane V, Koh JJK, Quek RYC, Ozdemir S, Finkelstein EA, et al. Perspectives on decision making amongst older people with end-stage renal disease and caregivers in Singapore: a qualitative study. Health Expect 2019;22(5):1100–10. Available from: https://doi.org/10.1111/hex.12943
Thomas N, Jenkins K, McManus B, Gracey B. The experience of older people in the shared decision-making process in advanced kidney care. Biomed Res Int 2016;2016:7859725. Available from: https://doi.org/10.1155/2016/7859725
Selman LE, Bristowe K, Higginson IJ, Murtagh FEM. The views and experiences of older people with conservatively managed renal failure: a qualitative study of communication, information and decision-making. BMC Nephrol 2019;20(1):38. Available from: https://doi.org/10.1186/s12882-019-1230-4
Sampath R, Seshadri S, Phan T, Allen R, Duberstein PR, Saeed F. Uncovering patient and caregiver goals for goal-concordant care in kidney therapy decisions. Am J Hosp Palliat Care 2024;41(11):1350–7. Available from: https://doi.org/10.1177/10499091241227242
Dahm MR, Raine SE, Slade D, Chien LJ, Kennard A, Walters G, 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. Available from: https://doi.org/10.1016/j.pec.2023.108124
Montalescot L, Dorard G, Speyer E, Legrand K, Ayav C, Combe C, et al. Patient perspectives on chronic kidney disease and decision-making about treatment: discourse of participants in the French CKD-REIN cohort study. J Nephrol 2022;35(5):1387–97. Available from: https://doi.org/10.1007/s40620-022-01345-6
Siamhong P, Sitthi S, Chanwong N, Phongsupa O. Factors associated with the selection of renal replacement therapy among patients with chronic renal failure based on the health belief model in Sri Songkhram District, Nakhon Phanom Province. J Nurs Sci Health Nakhon Phanom Univ 2023;1(1):12–23. (Thai)
Chiang PC, Hou JJ, Jong IC, Hung PH, Hsiao CY, Ma TL, et al. Factors associated with the choice of peritoneal dialysis in patients with end-stage renal disease. Biomed Res Int 2016;2016:5314719. Available from: https://doi.org/10.1155/2016/5314719
de Jong RW, Stel VS, Rahmel A, Murphy M, Vanholder RC, Massy ZA, et al. Patient-reported factors influencing the choice of kidney replacement treatment modality. Nephrol Dial Transplant 2022;37(3):477–88. Available from: https://doi.org/10.1093/ndt/gfab059
Sangsee P, Tanatwanit Y, Khunsongkiet W, Muangkum S. Factors related to self-determination to select dialysis modalities in patients with end-stage renal disease. J Nurs Burapha Univ 2020;28(3):52–65. (in Thai)
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