The Prepare for Kidney Care Study: prepare for renal dialysis vs responsive management in advanced chronic kidney disease

Shared decision making in advanced chronic kidney disease requires unbiased information on survival and person-centred outcomes known to matter to patients: quality of life, symptom burden and support from family and healthcare professionals. To date, when deciding between dialysis and conservative care, patients have had to rely on evidence from small observational studies. Clinicians recognise that like is not being compared with like in these studies and interpret the results differently. Further, support differs considerably between renal units. What patients choose therefore depends on which renal unit they attend. To address this, a programme of work has been underway in the UK. After reports on survival and symptoms from a small number of renal units, a national, mixed-methods study – conservative kidney management: assessing practice patterns – mapped out conservative care practices and attitudes in the UK. This led to the Prepare for Kidney Care study, a randomised controlled trial comparing preparation for dialysis versus preparation for conservative care. Although powered to detect a positivist 0.345 difference in quality adjusted life years between the two treatments, this trial also takes a realist approach with a range of person-centred secondary outcomes and embedded qualitative research. To understand generalisability it is nested in an observational cohort study, which is nested in a chronic kidney disease registry. Challenges to recruitment and retention have been rapidly identified and addressed using an established embedded mixed methods approach - the QuinteT recruitment intervention. This review considers the background to and progress with recruitment to the trial.