Potential Impact of Peer Mentoring on Treatment Choice in Patients with Chronic Kidney Disease: A Review

Chronic kidney disease (CKD) and the resultant end stage renal disease (ESRD) are associated with significant mortality, morbidity, and cost for the individual patient and society. CKD is among the major contributors to years of life lost (YLL) due to premature mortality. Also, while the disability adjusted life years (DALY) for many conditions decreased between 1990 and 2010, the DALY for CKD has increased by 69%. In addition to the physical disability, CKD is associated with high prevalence (27.9%) of major depressive episodes, associated with limitations of employment, and a significant negative effect on quality of life (QOL). A major determinant of QOL is satisfaction with treatment choice. There is consensus among investigators that patients who are actively engaged in their own care experience improved health outcomes. The shared decision making (SDM) approach allows patients and providers the opportunity to work in partnership to make decisions that are congruent with the patient's values, preferences, and distinct situations. SDM has been associated with improved outcomes among patients with various chronic disease states. Mentoring, particularly by trained peers, has been used as an approach to enhance SDM in several chronic conditions, including cancer and cardiovascular disease. In this review, we will focus on care of patients with CKD as a model for the study of the impact of peer mentoring on SDM and choice of treatment for ESRD.