The Author Replies:
We sincerely appreciate the insightful comments by Masaki et al.regarding our original article,1“Japanese Patients’ Perceptions of Shared Decision-Making in Renal Replacement Therapy.”2 They presented valuable findings from a single-center cohort of patients with stage 5 chronic kidney disease, describing 22 individuals who initially opted for conservative kidney management (CKM) at their first outpatient visit for renal replacement therapy selection and illustrating the dynamic trajectories of their treatment choices.
As noted in the limitations of our study,2 we included only patients who had already chosen dialysis or kidney transplantation; therefore, those who preferred CKM were not represented. As Masaki et al. highlighted, patients’ emotions and preferences evolve over time,3 and decision-making should be understood as a dynamic, ongoing process. In this regard, we fully agree that renal replacement therapy options should be revisited periodically, and that confirming patients’ genuine choices through multiple outpatient encounters is essential.
Nevertheless, it is important to acknowledge 2 additional realities. First, many patients are preoccupied with daily life and may lack the mental space to seriously consider future renal replacement therapy options unless they experience symptoms that substantially interfere with their daily activities.4 Second, treatment preferences may be influenced by family relationships and circumstances.5 For example, some patients may initially choose CKM under family pressure or strained relationships, whereas others may shift from CKM to dialysis out of a genuine desire to support family members whose health has deteriorated.3,5 Thus, patients who initially appear to prefer CKM may, in some cases, reflect these contextual realities rather than a fixed treatment preference.
References
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