ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005


The Latest on Twitter

Kidney Week

Abstract: SA-PO673

Nephrologist/Patient Conversations About Renal Replacement

Session Information

Category: Dialysis

  • 604 Home and Frequent Dialysis


  • Wise, Meg, University of Wisconsin-Madison, Madison, Wisconsin, United States
  • Schatell, Dorian R., Medical Education Institute, Madison, Wisconsin, United States
  • Chewning, Betty, University of Wisconsin, Madison, Wisconsin, United States
  • Chan, Micah R., University of Wisconsin-Madison, Madison, Wisconsin, United States

Patient-centered, valued-based decision-making is the gold standard for choosing complex medical treatments.


We conducted a mixed-method conversation study to understand how nephrologists and patients communicate about renal replacement therapy (RRT), with 8 nephrologists from 3 clinics and 61 of their patients with eGFR <25. Analysis of verbatim transcripts of audio-recorded clinic visits assessed word ratios and discussion of RRT options. Surveys collected demographics and RRT preferences.


Nephrologists established rapport with patients and worked to delay dialysis. RRT was the most uncomfortable part of the conversation for both nephrologists and patients: clinicians spoke ~3.25 times more in the whole visit, but ~8 times more about RRT, suggesting that patients shut down. In-center hemodialysis (HD), peritoneal dialysis (PD), and transplant (despite non-eligibility) were most often discussed; home HD was hardly discussed. Nephrologists’ used scripted didactic (teaching) versus dialogic (two-way) communication about RRT, perhaps overwhelming patients. Nephrologists may have inadvertently discouraged PD by emphasizing a need for a care partner (vs. optional), a sterile home (vs. just the dialysis room), and extensive training (vs. easy to learn). Home vs. center-borne infections, or that the “professionals” administering HD are largely technicians were not cited. Nephrologists did not talk about end-of-life or address patients’ emotional or existential concerns. They did not directly elicit patients’ values or tailor information-giving to those values even when patients inserted them. All but one nephrologist said they would use tools to help communicate more easily with their patients about RRT options.


A patient-centered values-based dialysis decision aid might serve as an ice-breaker, include the patients’ values into the RRT conversation, and increase patients’ participation in the RRT conversation and preferences for home dialysis.

Participant Demographics
Age, mean (range)39.43 (37-44)
Years of practice, mean (range)7 (2-10)
eGFR, mean (SD)20.62 (4.08)
Age, mean (SD), range68.82 (12.78) 25-94
Female36 (60%)
< College degree40 (65%)


  • Commercial Support