Background: Shared decision-making (SDM) is a key process in selecting renal replacement therapy (RRT). This study analyzed SDM perceptions, preferences, and patient- and facility-level factors influencing SDM among Japanese patients with chronic kidney disease (CKD) who selected RRT. Methods: We analyzed 475 adult patients with CKD from 49 medical facilities. SDM awareness and recognition, preferences for SDM timing and frequency, discussion content, and desired professional involvement were assessed. Patient- and facility-level factors associated with SDM perceptions were evaluated using Poisson regression with cluster-robust variance estimation. Results: The mean age of participants was 67.4 years. Overall, 71%, 24.4%, and 4.4% chose hemodialysis, peritoneal dialysis, and kidney transplantation, respectively. While 81.2% perceived that SDM was performed during RRT selection, only 4.7% were explicitly aware of the concept. Patients prioritized discussions about effects on daily life, financial burden, and family-related concerns. Most preferred SDM initiation when RRT was imminent, conducted over multiple sessions. Many patients valued the involvement of medical social workers and their usual non-nephrologist physicians in addition to nephrologists. Multiple outpatient visits for RRT selection, involving nurse participation and extended consultation times, were significantly associated with SDM perceptions (prevalence ratio: 1.59, 95% confidence interval: 1.05-2.42). Conclusions: Many Japanese patients with CKD perceived SDM during RRT selection; however, they had limited awareness of the concept. The findings underscore the importance of establishing a system that facilitates repeated SDM discussions at critical moments for patients. These discussions should emphasize the impact of RRT on patients' lives and involve a multidisciplinary team.

T. Sofue has received payment for speaking from Astrazeneca K.K. and Astellas Pharma Inc., Kyowa Kirin Co., Ltd. T. Toida has received consulting fees from Astellas Pharma Inc. and payment for speaking and educational events from Torii Pharmaceutical Co., Ltd., Ono Pharmaceutical Co., Ltd., Kyowa Kirin Co., Ltd., AstraZeneca K.K., Nobelpharma Co., Ltd., and Novo Nordisk Pharma Ltd. T. Suzuki has received payment for speaking and educational events from Astellas Pharma Inc, AstraZeneca K.K, Vantive Japan, Daiichi Sankyo Co.,Ltd., Janssen Pharmaceutical K.K, Kaneka Medix Corp, Kissei Pharmaceutical Co.,Ltd., Kowa Co.,Ltd., Kyowa Kirin Co.,Ltd, Mochida Pharmaceutical Co.,Ltd., Nobelpharma Co.,Ltd, Novartis Pharma K.K., Novo Nordisk Pharma.,Ltd., Ono Pharmaceutical Co.,Ltd., Otsuka Pharmaceutical, Terumo Corp, and Torii Pharmaceutical Co.,Ltd. HT has received consulting fees from Aplause Pharma, and payment for speaking from Kyowa Kirin Co., Ltd., Mochida Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Corporation, Terumo Corporation, JMS Co., Ltd., Vantive Japan, Torii Pharmaceutical Co., Ltd., Fuji Systems Corporation, and Sanwa Kagaku Kenkyujo Co., Ltd. RI has received payment for speaking and educational events from Vantive Japan. S. Shibata received personal fees and/or research funding from AstraZeneca, Bayer, Daiichi-Sankyo, Fuji Yakuhin, Kyowa-Kirin, Mochida, and Torii. NK has received consulting fees from GlaxoSmithKline K.K., and payment for speaking and educational events from Eisai Co., Ltd., Taisho Pharmaceutical Co., Ltd., Kyowa Kirin Co., Ltd., GlaxoSmithKline K.K., Takeda Pharmaceutical Co., Ltd., Kissei Pharmaceutical Co., Ltd., and Baxter Corporation.

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.

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The study was approved by the Fukushima Medical University Certified Review Board, Fukushima Medical University (No. ippan-2022).

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