Kidney Week

Abstract: SA-PO0916

Trust in the Usual Nephrologist, Patient Hope, and Shared Decision-Making Quality in Kidney Replacement Therapy Selection: A Multicenter Cross-Sectional Study

Session Information

• Health Maintenance, Nutrition, and Metabolism
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Health Maintenance, Nutrition, and Metabolism

• 1500 Health Maintenance, Nutrition, and Metabolism

Authors

• Suzuki, Tomo, Kameda Medical Center, Kamogawa, Chiba, Japan

Tomo Suzuki, MD, PhD

• Inanaga, Ryohei, Shin-Yurigaoka General Hospital, Kawasaki, Kanagawa, Japan

Ryohei Inanaga

• Toida, Tatsunori, Toho Daigaku Iryo Center Ohashi Byoin, Meguro, Tokyo, Japan

Tatsunori Toida, MD, PhD

• Sofue, Tadashi, Kagawa Daigaku, Takamatsu, Kagawa Prefecture, Japan

Tadashi Sofue, MD, PhD

• Kawarazaki, Hiroo, Teikyo University Hospital Mizonokuchi, Kawasaki, Kanagawa, Japan

Hiroo Kawarazaki, MD, PhD

• Shibagaki, Yugo, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan

Yugo Shibagaki, MD

• Kurita, Noriaki, Tokai Daigaku Igakubu Daigakuin Igaku Kenkyuka, Isehara, Kanagawa, Japan

Noriaki Kurita, MD, PhD

Background

Patients with chronic kidney disease (CKD) who face kidney replacement therapy (KRT) often experience diminished hope regarding their future, purpose in life, and health. Shared decision-making (SDM) involving multidisciplinary healthcare professionals may support treatment selection, and trust is considered central to effective SDM. However, factors associated with SDM quality remain poorly understood. We therefore investigated associations among trust in the nephrologist who usually followed the patient ("usual nephrologist"), patient hope, and SDM quality.

Methods

We conducted a multicenter cross-sectional study of adults with stage 5 CKD immediately after KRT modality selection at 49 centers in Japan between October 2022 and February 2025. Trust in the usual nephrologist was assessed with the Abbreviated Wake Forest Physician Trust Scale (A-WFPTS), hope with the Health-Related Hope Scale (HR-Hope), and SDM quality with the CollaboRATE scale. General linear models adjusted for age, frailty, depressive symptoms, socioeconomic factors, attendance of the usual nephrologist during KRT decision-making, and duration of the patient–physician relationship.

Results

A total of 462 patients were included. Higher A-WFPTS scores were associated with higher HR-Hope scores (coefficient per 1-point increase, 0.41; 95% CI, 0.29–0.53).
In models excluding HR-Hope, higher A-WFPTS scores were associated with higher SDM scores (0.72; 95% CI, 0.61–0.83). In models excluding trust, higher HR-Hope scores were also associated with higher SDM scores (0.17; 95% CI, 0.06–0.28).
However, when both variables were included, trust in the usual nephrologist remained associated with higher SDM scores (0.73; 95% CI, 0.62–0.84), whereas HR-Hope was no longer significant. Attendance of the usual nephrologist during KRT decision-making was independently associated with higher SDM scores compared with other dedicated KRT physicians (4.60; 95% CI, 1.58–7.62).

Conclusion

Trust in the usual nephrologist may help maintain patient hope and plays a central role in achieving high-quality SDM during KRT selection.

Acknowledgment

This study was supported by JSPS KAKENHI (grant numbers: JP19KT0021, JP21K10314, and JP22K19690). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Funding

• Government Support – Non-U.S.