- Design
- Multicentre randomised trial with blinded outcome assessment
- Population
- 453 adults aged 65 or older with advanced chronic kidney disease
- Primary outcome
- Advance care planning documented within 12 months
- Effect
- 56.6% vs 40.0%; difference 16.6 points (95% CI 7.5–25.7)
VIDEO-KD randomised 453 adults aged 65 or older with advanced chronic kidney disease at 12 US clinics. Mean age was 79. The intervention group watched a certified video showing three paths — haemodialysis, peritoneal dialysis and conservative kidney management — then recorded a statement of their goals and preferences, in video, audio or writing, which was sent to their clinician. Controls received usual care. Outcome assessors were blinded.
At 12 months, advance care planning was documented for 57% of the intervention group and 40% of controls. Documented discussion of kidney failure options rose from 32% to 46%. Straight after the video, far fewer patients were undecided (13% vs 41%), and half preferred conservative management, against a third of controls.
This matters on the medical ward as much as in clinic. Patients with advanced CKD are often admitted with a complication and pushed towards a dialysis decision without a prior conversation. A documented preference changes what the admitting team does.
The trial measured documentation and stated preference, not what treatment patients eventually received or how they felt about it. The population was largely white and American, and a video in English will not translate directly to every Indian clinic, but the principle — show the options, record the choice — travels well.
- Raise dialysis and conservative management as options with every older patient approaching kidney failure, before a crisis.
- Use a structured decision aid, video or written, so the options are shown rather than only described.
- Record the patient's stated preference somewhere the admitting team will see it.
- Revisit the decision at each significant change in kidney function or health status.
- Present conservative kidney management as a legitimate choice, not a failure to treat.
Why it matters
Dialysis decisions in older adults too often happen on the ward, in a crisis, without any prior conversation on record.
Don't overread it
More documentation is not proof of better care or of decisions patients later endorsed.
The statistics, in plain English
A rate difference of 16.6 percentage points (95% CI 7.5 to 25.7) means about one extra documented plan for every six patients who used the aid. The interval is well clear of zero. The shift in stated preference is a secondary finding and does not show patients were better served by their final decision.
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