- Design
- Multicentre randomised trial, assessor-masked, 12 months
- Population
- 453 adults aged 65+ with advanced CKD, 12 US clinics
- Primary outcome
- Advance care planning documentation within 12 months
- Effect
- 56.6% vs 40.0%; difference 16.6% (95% CI 7.5-25.7)
VIDEO-KD randomised 453 adults aged 65 or over (mean 79) with advanced chronic kidney disease at 12 US clinics. The intervention group watched a video showing haemodialysis, peritoneal dialysis and conservative kidney management, then recorded a statement of their goals and preferences that went to their clinician. Published in JAMA Internal Medicine on 22 October 2026.
At 12 months, advance care planning was documented in 57% versus 40% (difference 16.6 percentage points, 95% CI 7.5 to 25.7). Documented discussion of treatment options was also higher. After the video, far fewer patients were undecided (13% vs 41%) and more preferred conservative management (51% vs 32%).
Many older patients start dialysis without a real conversation about alternatives. A short video makes that conversation happen and shows that many, once informed, prefer not to dialyse.
The outcome was documentation, not whether care matched wishes, and most participants were White Americans.
- Raise conservative kidney management as a genuine option with older patients nearing kidney failure
- Use a structured aid, video or printed, before the dialysis decision becomes urgent
- Record the patient's stated preferences where every team will see them
- Revisit the decision as function declines; preferences change
Why it matters
Once informed, half of these older patients leaned towards not dialysing, which suggests usual care leaves the option unspoken.
Don't overread it
The trial measured documentation, not whether patients received the care they wanted.
The statistics, in plain English
The 16.6-point increase has a confidence interval from 7.5 to 25.7, so even the cautious estimate is a meaningful rise. Outcome assessors were masked, which reduces bias in judging the notes.
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