Study shows myKIDNEY helps patients make better informed choices

For an elderly patient facing end-stage kidney disease, the default answer has long been dialysis. But a new study by Duke-NUS Medical School and its collaborators at Singapore General Hospital (SGH) and the National University Hospital (NUH) suggests that giving patients and their families the right information, at the right time, can meaningfully change that calculus.

The study, published in Kidney International Reports, evaluated myKIDNEY, a web-based patient decision aid (PDA) developed by a team of researchers from Duke-NUS, SGH, and NUH in 2020.

When used alongside counseling, myKIDNEY was found to reduce patients’ decisional conflict, the uncertainty and anxiety that often accompanies high-stakes medical choices, while raising awareness of conservative management as an accepted alternative to dialysis.

Conservative management focuses on symptom relief and quality of life through lifestyle changes and medication, without the physical demands of dialysis treatment.

Chronic kidney disease affects 14.9% of Singapore residents—higher than the global rate of 14.2%. 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 counseling workflows to support patients and families navigating these decisions.

What the study found

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 counseling using existing educational materials, and an intervention group, which received counseling integrated with the myKIDNEY web tool, which included information on the various treatment options, video testimonials from other patients, and a tool to help 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 counseling 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 counseling, 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.

Professor Eric Finkelstein, Executive Director of the Lien Center 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 counseling 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.

“Enrollment into an artificial life support program with hemodialysis or peritoneal dialysis results in high care burden which may not meaningfully prolong high quality of 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.”

The research team is now looking to expand access to myKIDNEY through partnerships with additional health care institutions across Singapore.