Patient and carer treatment preferences for oral medication in chronic kidney disease: a discrete choice experiment across eight countries.

BACKGROUND: Chronic Kidney Disease (CKD) affects over 674 million people globally and can lead to kidney failure, which significantly impairs quality and duration of life. While various oral pharmacological treatment options are available, limited research exists on how patients and carers prioritise treatment attributes. This study explored preferences for oral CKD medication across eight countries, involving 2,324 participants (1,511 patients and 813 carers).
METHODS: A Discrete Choice Experiment (DCE) was conducted in which participants completed seven hypothetical scenarios, each with two unlabelled treatment options and a "neither" (or "stay on current treatment") option. Five attributes were assessed: delay in dialysis or transplant, life extension, reduced risk of heart failure hospitalisation, risk of side effects, and out-of-pocket costs. Data were analysed using Mixed Multinomial Logit models, generating separate patient and carer models for each country (16 models), enabling cross-country comparisons.
RESULTS: Participants across countries placed the highest importance on delaying dialysis or transplant, followed by life extension, with minimising treatment side effects ranked next. They preferred longer delays for dialysis or transplant, with the seven-year delay being most preferred. Regional and patient-carer variations were observed in attribute importance. Model parameters were used to calculate utility for treatment profiles and simulate preference shares, enabling country-level comparisons.
CONCLUSION: Patients and carers consistently prioritised oral medications that delay the need for dialysis or transplant and extend life, although the relative importance of these attributes differed by country and respondent group. The choice of oral medication in CKD is preference-sensitive, and these results have direct implications for shared decision-making in clinical practice. To support application of these findings, we have developed an interactive dashboard that simulates the impact of medication attributes on predicted uptake across all eight countries: https://cappre.shinyapps.io/CKD_Dapa_DCE/.