Abstract
Background: The number of people living with kidney disease (acute kidney injury, chronic kidney disease, and treated kidney failure) worldwide is reported to exceed 850 million (Bello et al., 2024). The number of people undergoing maintenance dialysis globally has increased dramatically. Chronic kidney disease (CKD) is not only a public health issue but also creates an economic burden (Lee et al., 2023). For patients with ESRD, a planned approach to establishing dialysis access is a critical priority.
Purpose: The pre-establishment of permanent vascular access and peritoneal catheters for dialysis is essential to reduce the need for repeated temporary tube placements, thereby decreasing hospitalization days and infection rates. This study explores the impact of shared decision-making (SDM) on the pre-establishment of these dialysis access routes.
Methods: Participants in this study included both outpatient and inpatient cases from a medical center in northern Taiwan who had chronic renal failure for more than three months and a glomerular filtration rate (GFR) below 15 mL/min/1.73 Square meter in two consecutive outpatient visits. During the first stage of SDM, physicians initiated discussions about dialysis mode selection. Nephrology case managers and health education nurses acted as counselors, guiding patients and their families to decide on a preferred dialysis mode using SDM tools (such as educational leaflets, videos, and templates). When patients’ blood creatinine levels reached ≥6 mg/dL, the second stage of dialysis preparation was initiated, referring patients to the surgical clinic for hemodialysis vascular access or coordinating with a general surgeon for peritoneal dialysis catheter placement.
Results: Following the introduction of SDM and the facilitator model in 2019, statistics from 2019 to 2023 show that 689 out of 763 patients (90.30%) diagnosed with end-stage renal disease completed dialysis mode selection and met the criteria for permanent vascular access or peritoneal catheter pre-establishment. Of these, 185 out of 253 patients (73.12%) completed pre-establishment of permanent access (including both autologous and synthetic arteriovenous access and peritoneal dialysis catheters). The implementation of SDM and counseling models significantly increased the pre-establishment rate of permanent access, from 46.51% before SDM implementation to 73.12% afterward, demonstrating a statistically significant difference (t = -5.208, df = 5, p < .001).
Notes
References:
1. Bello, A. K., Okpechi, I. G., Levin, A., Ye, F., Damster, S., Arruebo, S., Donner, J. A., Caskey, F. J., Cho, Y., Davids, M. R., Davison, S. N., Htay, H., Jha, V., Lalji, R., Malik, C., Nangaku, M., See, E., Sozio, S. M., . . . ISN-GKHA Group. (2024). An update on the global disparities in kidney disease burden and care across world countries and regions. The Lancet. Global Health, 12(3), e382-e395. https://doi.org/10.1016/S2214-109X(23)00570-3
2. Lee, Y. K., Kim, Y. H., Kim, D. H., Kim, J. H., Lee, J. H., Park, J. H., Ko, G. J., Hwang, W. M., Gil, H. W., Kang, Y. S., Jin, K. B., Do, J. Y., Kim, S. J., Kim, B. S., & Shin, H. S. (2023). Shared decision-making intervention regarding dialysis modality in patients with CKD stage 5. Medicine, 102(19), Article e33695. https://doi.org/10.1097/MD.0000000000033695
Sigma Membership
Non-member
Type
Poster
Format Type
Text-based Document
Study Design/Type
Other
Research Approach
Other
Keywords:
Public and Community Health, Kidney Disease, CKD, Dialysis Access, Dialysis Patients, Taiwan
Recommended Citation
Chang, Shu Ju and Tsai, Yen ping, "Shared Decision-Making to Increase the Pre-Establishment Rate in First-Time Dialysis Patients" (2025). International Nursing Research Congress (INRC). 61.
https://www.sigmarepository.org/inrc/2025/posters_2025/61
Conference Name
36th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Seattle, Washington, USA
Conference Year
2025
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Shared Decision-Making to Increase the Pre-Establishment Rate in First-Time Dialysis Patients
Seattle, Washington, USA
Background: The number of people living with kidney disease (acute kidney injury, chronic kidney disease, and treated kidney failure) worldwide is reported to exceed 850 million (Bello et al., 2024). The number of people undergoing maintenance dialysis globally has increased dramatically. Chronic kidney disease (CKD) is not only a public health issue but also creates an economic burden (Lee et al., 2023). For patients with ESRD, a planned approach to establishing dialysis access is a critical priority.
Purpose: The pre-establishment of permanent vascular access and peritoneal catheters for dialysis is essential to reduce the need for repeated temporary tube placements, thereby decreasing hospitalization days and infection rates. This study explores the impact of shared decision-making (SDM) on the pre-establishment of these dialysis access routes.
Methods: Participants in this study included both outpatient and inpatient cases from a medical center in northern Taiwan who had chronic renal failure for more than three months and a glomerular filtration rate (GFR) below 15 mL/min/1.73 Square meter in two consecutive outpatient visits. During the first stage of SDM, physicians initiated discussions about dialysis mode selection. Nephrology case managers and health education nurses acted as counselors, guiding patients and their families to decide on a preferred dialysis mode using SDM tools (such as educational leaflets, videos, and templates). When patients’ blood creatinine levels reached ≥6 mg/dL, the second stage of dialysis preparation was initiated, referring patients to the surgical clinic for hemodialysis vascular access or coordinating with a general surgeon for peritoneal dialysis catheter placement.
Results: Following the introduction of SDM and the facilitator model in 2019, statistics from 2019 to 2023 show that 689 out of 763 patients (90.30%) diagnosed with end-stage renal disease completed dialysis mode selection and met the criteria for permanent vascular access or peritoneal catheter pre-establishment. Of these, 185 out of 253 patients (73.12%) completed pre-establishment of permanent access (including both autologous and synthetic arteriovenous access and peritoneal dialysis catheters). The implementation of SDM and counseling models significantly increased the pre-establishment rate of permanent access, from 46.51% before SDM implementation to 73.12% afterward, demonstrating a statistically significant difference (t = -5.208, df = 5, p < .001).
Description
Increasing the number of pre-established dialysis access cases helps prevent the need for repeated temporary access placements, reduces infection risks, and lowers hospitalization rates and costs. This approach enhances patient-centered care and improves overall quality of care.