Renal replacement therapy decisions emphasize which principle before starting dialysis?

• A. Shared decision making.
• B. Immediate initiation of dialysis.
• C. Exclusive choice of hemodialysis.
• D. Avoidance of transplantation.

Answer: (A)

Before starting dialysis, decisions about renal replacement therapy should be guided by shared decision making. This means clinicians actively partner with the patient (and family when appropriate) to discuss goals of care, explain all available options—dialysis modalities and transplantation—and lay out the risks, benefits, and what daily life looks like with each path. When the plan reflects the patient’s values, priorities, and overall prognosis, the timing and method of initiation are more likely to align with what matters most to them, and consent is truly informed. This collaborative approach also helps avoid starting dialysis sooner or later than is appropriate and keeps transplant options on the table where suitable. In contrast, pursuing an immediate start, defaulting to one modality, or avoiding transplantation altogether do not reflect this patient-centered decision-making process.