Shared decision making in renal replacement therapy should reflect patient values. However, the quantitative impact of family involvement—particularly in Asian contexts—on decision-making quality remains underexplored. This nationwide, multicenter cross-sectional study (October 2022–February 2025) involved 475 adults with stage 5 chronic kidney disease across 49 facilities in Japan. Following the selection of renal replacement therapy, participants were surveyed regarding the final decision-makers and their specific roles. Shared decision-making quality was evaluated using the three-item CollaboRATE scale, assessing information exchange and preference integration. Compared with “physician-only” decisions, CollaboRATE scores (points; 95% confidence interval) were significantly higher in the “patient and physician” (+ 12.3; 1.5–23.2) and “patient, physician, and key person” groups (+ 13.7; 0.8–26.7). Role-based analyses showed that shared decision-making with the physician or key person was associated with a + 10.0 point increase (3.2–16.8) versus decisions without patient involvement. Among patients having family, scores were significantly higher for patient only (+ 9.5), patient-led with input from physician or key person (+ 10.4), and shared decision-making (+ 12.1) categories, compared with no patient involvement. Family involvement enhances shared decision-making quality when selecting renal replacement therapy, particularly when the process remains collaborative and guided by patient preferences.
Using phosphate binders (PBs) to control hyperphosphatemia in patients undergoing hemodialysis is associated with substantial pill burden. In this post hoc phase 3 analysis, we evaluated the benefit of the selective sodium/hydrogen exchanger isoform 3 inhibitor, tenapanor, in reducing pill burden in these patients. Patients received oral tenapanor starting at 5 mg twice daily and PBs. Dose adjustments of PBs and tenapanor were based on serum phosphorus levels. Changes in daily PB pill count, daily equivalent dose of PBs, number of combined PBs used, PB dose frequency, and tenapanor dose at Week 50 were analyzed according to patient background factors. The analysis comprised 204 patients (followed up for Week 50: 154 patients). Factors affecting the tenapanor dose at Week 50 were sex (P = 0.029), age (< 65 vs. ≥ 65 years; P = 0.008), normalized protein catabolic rate (< 0.80 vs. ≥ 1.00; P = 0.019), presence of diabetic nephropathy (P = 0.038), constipation (P = 0.015), and the occurrence of diarrhea as an adverse event (P = 0.009). Tenapanor consistently reduced the daily PB pill count and equivalent dose of PBs from baseline to Week 50 across all patient background factors evaluated (all P < 0.001 vs. baseline), thus demonstrating the clinical benefit of tenapanor regardless of patient background characteristics.Clinical Trial Registration ClinicalTrials.Gov (NCT04771780).
