title: The Concordance between Patients' Renal Replacement Therapy Choice and Definitive Modality: Is It a Utopia?
abstract: BACKGROUND
  It is desirable for patients to play active roles in the choice of renal replacement therapy (RRT). Patient decision aid tools (PDAs) have been developed to allow the patients to choose the option best suited to their individual needs.
  
  
  METHODS
  An observational, prospective registry was conducted in 26 Spanish hospitals between September 2010 and May 2012. The results of the patients' choice and the definitive RRT modality were registered through the progressive implementation of an Education Process (EP) with PDAs designed to help Chronic Kidney Disease (CKD) patients choose RRT.
  
  
  RESULTS
  Patients included in this study: 1044. Of these, 569 patients used PDAs and had made a definitive choice by the end of registration. A total of 88.4% of patients chose dialysis [43% hemodialysis (HD) and 45% peritoneal dialysis (PD)] 3.2% preemptive living-donor transplant (TX), and 8.4% conservative treatment (CT). A total of 399 patients began RRT during this period. The distribution was 93.4% dialysis (53.6% HD; 40% PD), 1.3% preemptive TX and 5.3% CT. The patients who followed the EP changed their mind significantly less often [kappa value of 0.91 (95% CI, 0.86-0.95)] than those who did not follow it, despite starting unplanned treatment [kappa value of 0.85 (95% CI, 0.75-0.95]. A higher agreement between the final choice and a definitive treatment was achieved by the EP and planned patients [kappa value of 0.93 (95% CI, 0.89-0.98)]. Those who did not go through the EP had a much lower index of choosing PD and changed their decision more frequently when starting definitive treatment [kappa value of 0.73 (95% CI, 0.55-0.91)].
  
  
  CONCLUSIONS
  Free choice, assisted by PDAs, leads to a 50/50 distribution of PD and HD choice and an increase in TX choice. The use of PDAs, even with an unplanned start, achieved a high level of concordance between the chosen and definitive modality.
authors.affiliation: Department of Nephrology, Complejo Asistencial Universitario de León, León, Spain.
authors.forename: Mario
authors.initials: M
authors.lastname: Prieto-Velasco
authors.affiliation: Department of Nephrology, Hospital Universitario de Puerto Real, Puerto Real, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Quiros
authors.affiliation: Department of Nephrology, Hospital Universitario de Puerto Real, Puerto Real, Spain.
authors.forename: Cesar
authors.initials: C
authors.lastname: Remon
mesh_terms: D000368:Aged; D002755:Choice Behavior; D003657:Decision Making; D003661:Decision Support Techniques; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007676:Kidney Failure, Chronic / Q000473:pathology / Q000523:psychology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010358:Patient Participation / Q000523:psychology / Q000706:statistics & numerical data; D011446:Prospective Studies; D012042:Registries; D006435:Renal Dialysis / Q000379:methods / Q000523:psychology*; D013030:Spain