SINGAPORE, 30 APRIL 2026 — In the realm of nephrology, the management of end-stage kidney disease (ESKD) in elderly patients has traditionally revolved around dialysis, often regarded as the inevitable course of treatment. However, a groundbreaking study spearheaded by Duke-NUS Medical School in collaboration with Singapore General Hospital (SGH) and National University Hospital (NUH) challenges this prevailing dogma. The research reveals that equipping patients and their families with nuanced, timely information through a dedicated decision aid radically transforms treatment choices, steering discussions beyond dialysis towards more individualized, patient-centered care pathways.
Chronic kidney disease (CKD) casts a wide net globally, but the disease’s concerning prevalence in Singapore—affecting approximately 14.9% of residents, surpassing the global average of 14.2%—poses urgent public health challenges. As Singapore’s population ages, a significant proportion of elderly patients with multiple comorbidities confront the harsh realities of dialysis, which often offers marginal survival benefit compared to conservative management. Conservative management, emphasizing symptom control and quality of life via non-dialytic interventions, emerges not only as a less burdensome but also a cost-effective alternative. Historically, however, awareness and consideration of this option among patients and caregivers have been limited, leaving many defaulting to the dialysis pathway without a full understanding of the implications.
Against this backdrop, the study examined the effectiveness of myKIDNEY, a web-based patient decision aid (PDA) developed in 2020 by researchers from Duke-NUS, SGH, and NUH. Unlike traditional counseling relying on static educational materials, myKIDNEY integrates multimedia resources including video testimonials from patients, interactive modules elucidating treatment options, and tools designed to clarify patient values and priorities. By embedding this PDA into the standard counseling workflow from October 2024, renal coordinators facilitated a more dynamic dialogue with patients faced with complex treatment decisions.
The clinical trial enrolled 143 participants between 2021 and 2024, encompassing 75 elderly patients aged 70 and above diagnosed with ESKD and 68 caregivers actively involved in care decisions. Participants were segregated into a control group undergoing conventional counseling and an intervention group receiving counseling supplemented with myKIDNEY. The trial’s primary endpoints focused on decisional conflict—a measure of uncertainty and anxiety during decision-making—and awareness of conservative management as a legitimate care avenue. Subsequent treatment choices were tracked six months post-intervention to evaluate real-world impact.
Results underscored the transformative power of informed shared decision-making. Patients utilizing the myKIDNEY tool exhibited substantially lower decisional conflict scores compared to those receiving standard counseling alone, indicating reduced anxiety and greater confidence in their choices. Notably, awareness of conservative management escalated to 82.6% within the intervention group, compared to 69.2% in controls, marking a significant elevation in informed understanding. Optimal alignment between patient values and treatment decisions was evidenced by a higher inclination towards conservative management among myKIDNEY users six months after counseling, reaffirming the tool’s role in fostering preference-concordant care.
An exploration of expert perspectives deepens the implications of this advancement. Professor Eric Finkelstein, Executive Director of the Lien Centre for Palliative Care and senior author, asserts that myKIDNEY reframes dialysis from being the de facto treatment to one feasible option among others, thereby enabling patients and families to weigh quality of life, treatment burden, and personal values collectively. This holistic approach is paramount in gerontological nephrology, where the therapeutic imperative extends beyond mere survival to encompass nuanced patient-centered goals.
Associate Professor Lina Choong of SGH emphasizes that dialysis entails invasive procedures such as arteriovenous fistula or graft creation, often compromising quality of life outcomes that some elderly patients desire to avoid. myKIDNEY supplements the counseling process, allowing patients to dissect all facets of available treatments and correlate them with individual objectives, thereby enhancing agency and empowerment. Concurrently, Associate Professor Jimmy Teo from NUH highlights how conservative kidney care—focusing on symptom relief in patients grappling with complex, coexisting terminal illnesses—avoids the high care burden associated with artificial life support programs like hemodialysis, while not forsaking disease management.
Dr. Chan Gek Cher, also from NUH’s Division of Nephrology, articulates that myKIDNEY respects the subjectivity inherent in quality-of-life assessments, facilitating reflection on personal priorities and promoting collaborative decision-making with caregivers. Importantly, the tool does not dictate a treatment pathway but frames choices within the spectrum of dialysis and supportive care, underscoring patient autonomy. The ethos of ‘living well and leaving well’ encapsulates this paradigm, orienting treatment toward holistic wellbeing rather than biomedical metrics alone.
Professor Lok Sheemei from Duke-NUS lauds the study’s findings as an exemplar of how patient decision aids transcend informational dissemination, catalyzing empowerment, aligning treatments with true patient preferences, and curtailing unnecessary interventions. In the context of an aging demographic with intricate comorbidities, personalized care planning tools such as myKIDNEY portend a paradigm shift in nephrology, fostering nuanced dialogues that honor the complexity of patient values and clinical realities.
This study’s insights herald a broader transformation in chronic disease management—where informed choice, patient autonomy, and quality-of-life considerations are integrated systematically into clinical practice. The researchers aim to broaden the deployment of myKIDNEY across additional healthcare institutions in Singapore, envisioning a future where decision aids become standard fixtures in patient counseling frameworks across various specialties.
By demonstrating robust evidence from a randomized controlled trial, this research illustrates the dual potency of technology and human-centered care in managing chronic illness. myKIDNEY exemplifies how digital tools can augment clinical counseling, mitigate decisional conflict, and foster decisions aligned with patient goals and circumstances, thereby advancing the science of shared decision-making in nephrology.
Continued research and expanded adoption of interventions like myKIDNEY are poised to recalibrate treatment paradigms, especially within aging populations facing multifactorial health challenges. As the population landscape shifts towards increased longevity paired with complex health profiles, such innovations will be critical in maintaining dignity, autonomy, and quality of life while navigating the high-stakes terrain of end-stage organ disease management.
Subject of Research: People
Article Title: Evaluation of a Decision Aid in Kidney Care Counseling for Older Adults
News Publication Date: 30 April 2026
Web References:
– Study: https://www.kireports.org/article/S2468-0249(26)02602-1/fulltext
– DOI: http://dx.doi.org/10.1016/j.ekir.2026.106371
References:
– Kidney International Reports, 25-Feb-2026, DOI: 10.1016/j.ekir.2026.106371
Keywords: Nephrology, Health counseling, Chronic kidney disease, End-stage kidney disease, Dialysis, Conservative management, Patient decision aid, Shared decision making
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