Using the myKIDNEY app boosted awareness of conservative management from 69.2% to 82.6% for chronic kidney disease patients.
A web-based patient decision aid ‘myKIDNEY’ is designed for chronic kidney disease care. By pairing this digital tool with professional counseling, patients and families reported significantly lower decisional conflict.(1✔ ✔Trusted Source
Evaluation of a Decision Aid in Kidney Care Counseling for Older Adults
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For elderly patients with end-stage kidney disease, dialysis has long been the default option, but it isn’t the only path to a high quality of life. A groundbreaking study by Duke-NUS Medical School, SGH, and NUH reveals that the right information can reshape this difficult journey.
The app clarifies the benefits of conservative management, an alternative focusing on quality of life and symptom relief over the physical strain of dialysis. This patient-centered approach ensures informed choices that prioritize comfort and personal values.
Conservative Management: A Viable Path for Chronic Kidney Disease
Chronic kidney disease affects 14.9 per cent of Singapore residents – higher than the global rate of 14.2 per cent. As the population ages, more elderly patients are being confronted with the reality that for older patients with multiple conditions.
Dialysis offers minimal survival advantage over conservative management, is associated with higher hospitalization rates, and places a significantly greater burden on patients and caregivers. It is also much more expensive. Yet awareness of conservative management as a viable path is not well understood.
Since October 2024, renal coordinators at SGH and NUH have been incorporating myKIDNEY into their counselling workflows to support patients and families navigating these decisions.
Decisional Aid Reduces Conflict in Chronic Kidney Disease Care
The study recruited 143 participants between 2021 and 2024 – 75 patients aged 70 and above with end-stage kidney disease, and 68 caregivers. Participants were divided into a control group, which received standard kidney care counselling using existing educational materials.
Also, an intervention group, which received counselling integrated with the myKIDNEY web tool, which included information on the various treatment options, video testimonials from other patients. The tool helped to clarify what is important to the patients concerning their care. The actual treatment chosen was recorded six months later.
The results were striking. Patients exposed to the decision aid showed significantly lower decisional conflict scores compared to those who received standard counselling alone. Awareness of conservative management was also markedly higher in the intervention group (82.6%) versus the control group (69.2%).
The study found that six months after counselling, patients who used myKIDNEY were more likely to opt for conservative management. This suggests a better understanding of the care option, which ensures that the patient’s underlying chronic kidney disease and its associated complications are still being treated.
Expert Perspectives: Why Personalized Kidney Care Matters
Professor Eric Finkelstein, Executive Director of the Lien Centre for Palliative Care at Duke-NUS Medical School and senior author of the study, said:
“For too long, dialysis has been treated as the only answer for end-stage kidney disease among elderly patients. By presenting conservative management as a viable treatment option, myKIDNEY enables patients and their families to weigh quality of life, treatment burden and personal values – and make a choice that is truly reflective of their preferences and goals for care.”
Associate Professor Lina Choong, Senior Consultant, Department of Renal Medicine, SGH, said:
“Active treatment such as dialysis, along with going through the invasive procedures required to start dialysis like creating a graft or fistula, may not result in the quality of life that some patients desire. myKIDNEY supports the counselling process, helping them to better understand all aspects of available care options and their own personal goals, and empower them to make informed decisions.”
Associate Professor Jimmy Teo Boon Wee, Senior Consultant, Division of Nephrology, Department of Medicine, NUH, said:
“Conservative kidney care or renal supportive care has always been part of the management of end-stage kidney failure at NUH. The development of myKIDNEY improves the decision-making process of patients when confronted with a terminal illness. Enrolment into an artificial life support program with hemodialysis or peritoneal dialysis results in high care burden which may not meaningfully prolong high quality life.”
“Conservative management is a better option for many older patients with multiple serious medical conditions, including end-stage vascular disease, end-stage heart failure, or other severe organ failures besides kidney failure.”
Dr. Chan Gek Cher, Senior Consultant, Division of Nephrology, Department of Medicine, NUH, said:
“myKIDNEY is a patient decision-support tool designed to guide older individuals through the complex process of choosing their kidney care pathway. Rather than prescribing a specific option, it empowers older patients and their caregivers to explore choices together and make informed, personal decisions.”
“Recognizing that quality of life can be subjective, the tool aids patients to reflect on what matters most to them. It also raises awareness of available care options, including dialysis and kidney supportive care programs at NUH. Ultimately, it supports our mission of helping patients with kidney disease in ‘living well and leaving well’.”
Professor Lok Sheemei, Duke-NUS’ Interim Vice-Dean for Research, said:
“Patient decision aids like myKIDNEY do more than inform – they empower. They show real promise in reducing unnecessary treatment and ensuring care is aligned with what older patients actually want and need. In geriatric nephrology, where personalized care planning is essential, tools like this can make a profound difference.”
Reference:
- Evaluation of a Decision Aid in Kidney Care Counseling for Older Adults – (https://www.kireports.org/article/S2468-0249(26)02602-1/fulltext)
Source-Eurekalert