Abstract: FR-PO0420
Describing Patient Heterogeneity in Discrete Choice Preferences for New Kidney Replacement Technologies
Session Information
- Dialysis: Measuring and Managing Symptoms and Syndromes
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Mir, Nabaan Azwad, University of California San Francisco School of Medicine, San Francisco, California, United States
- Trieu, Desmond, University of California San Francisco Department of Clinical Pharmacy, San Francisco, California, United States
- Vargas, Ruben, University of California San Francisco Department of Clinical Pharmacy, San Francisco, California, United States
- Frassetto, Lynda, University of California San Francisco Department of Medicine, San Francisco, California, United States
- Roy, Shuvo, University of California San Francisco Department of Bioengineering and Therapeutic Sciences, San Francisco, California, United States
- Wilson, Leslie, University of California San Francisco Department of Clinical Pharmacy, San Francisco, California, United States
Background
Kidney Replacement Therapies (KRT) do not support the prevalence of ESRD or patient preferences for in-home treatments. Artificial kidney devices can potentially solve both. We provide patient risk benefit tradeoffs for new KRTs to support their first in human use.
Methods
We conducted a discrete choice experiment (DCE) using a previously developed conjoint survey to assess heterogeneity of ESRD patients’ preferences for KRTs (Wilson, 2024). The DCE was a random, full profile, balanced-overlap design using Sawtooth for online administration to 498 patients, who chose from fourteen randomly generated choice pairs of risks (infection, death, device failure, surgeries) and benefits (mobility, diet, pill burden, follow-up, fatigue) of KRTs. We stratified by demographics, education, income, insurance, treatment modality and length. Analysis was mixed-effects regression with attributes as interaction terms, latent class analysis, and simultaneous maximal accessible risk thresholds (SMART).
Results
Race, age, gender groups did not differ significantly in preferences for most risks/benefits of KRT. Mobility remained top priority across demographic groups (femaleβ=1.58, maleβ=1.77; youngβ=1.74, olderβ=1.55). Females significantly more strongly preferred avoiding frequent surgery (β=0.53, p=0.003) and device rejection (β=-0.17, p=0.02). Younger patients significantly preferred avoiding all fatigue (β=0.25 & β=0.26, p=0.02). Moderate income groups had significantly stronger preference for gaining mobility than low income groups (β=0.59, p=0.02), and also had stronger preferences for avoiding all fatigue levels (β=0.36 & 0.55, p=0.008 & 0.0002) and highest mortality risk (β=-0.50, p=0.05), than low income groups. Group2 of latent class analysis showed much stronger preferences for gaining highest mobility (β=3.7vsβ=0.48) and other KRT benefits (avoiding fatigue: β=1.09vsβ=0.68), and similar preferences for avoiding their risks than Group1. SMART analysis shows effects of trading simultaneous risks for gains in each benefit.
Conclusion
Strongest patient preferences were for improving mobility. Patients were willing to make risk-benefit tradeoffs needed for KRT acceptance. The CKD patients with strongest preferences for making the risk/benefit trade-offs for use of KRTs could be early adopters for their first in human approval.
Funding
- Other NIH Support