A Scoping Review on Decision-Making Interventions for Kidney Failure Treatment Options by the Kidney Disease Aging Research Collaborative.

BACKGROUND

Patients with kidney disease face complex treatment decisions amid prognostic uncertainty. These decisions may be particularly challenging for older adults, who often experience cognitive and functional changes and rely on caregivers. However, limited evidence describes treatment decision-making interventions for older adults, including the decision points addressed, use of decision aids, and geriatric-relevant SDM features, including caregiver involvement, values clarification, multiple touchpoints, and prognostic information.

METHODS

We conducted a scoping review of studies examining kidney failure treatment decision-making interventions that included ≥ 1 older patient(s) (≥ 65) with advanced kidney disease. We searched seven databases from inception through 4/2026. We characterized interventions by decision point, type of decision support provided, outcomes, exclusive enrollment of older adults, and presence of geriatric-relevant SDM features.

RESULTS

We identified 32 studies (of 2060 screened), representing 26 interventions. Seven interventions examined conservative kidney management versus dialysis, five dialysis modality, five dialysis versus transplant, and nine multiple treatment options. Among these, 11 (42%) included caregivers, 20 (77%) had multiple touchpoints, 19 (73%) included values clarification, and 12 (46%) incorporated prognostic data. Most interventions (22, 85%) incorporated decision aids. Of 137 outcomes reported, 13 (9%) were clinical. Nine interventions (35%) were evaluated exclusively among older adults.

CONCLUSIONS

Patient decision aids were common in kidney failure treatment decision-making interventions, but incorporation of geriatric-relevant SDM features varied across decision points, and few interventions were evaluated exclusively among older adults. Future interventions should tailor geriatric-relevant SDM features to specific treatment decisions to best support older adults in making kidney failure treatment decisions.