The Renal Physicians Association has released a free iPad app to assist nephrologists with shared decision-making (SDM) and pain and symptom management for acute kidney injury (AKI), chronic kidney disease and end-stage renal disease patients at the point of care.

Adam Weinstein, MD, a RPA Board Member and the leader of the app development team, said that the RPA SDM Toolkit app is an interactive, workflow-driven version of the RPA's Clinical Practice Guideline on Shared Decision Making in the Appropriate Initiation of and Withdrawal from Dialysis, 2nd Edition. It offers nephrologists the tools and recommendations with which they can aid adult and pediatric patients who have AKI, CKD, or ESRD in initiating, withholding and withdrawing dialysis. This app combines the benefits of the evidence-based guideline—consensus expert opinion informed by ethical principles, case and statutory law, and systematic review of research evidence—with a step-by-step approach to working through the process of decision making and symptom assessment with the patient and family in real time.

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Alvin H. Moss, MD, Director, Center for Health Ethics and Law, West Virginia University, who headed the SDM Guideline Revision Working Group, said that clinicians want to strengthen collaborative decision-making but have struggled to do so. "The RPA SDM app puts into the hands of the rounding nephrologist and other clinicians multiple evidence-based, easy-to-use tools which can be used to improve the quality of care for their patients with kidney disease. The app fills in the knowledge gap of nephrologists who did not learn about palliative and end-of-life care for CKD and ESRD patients in fellowship training."

Highlights include a validated prognosis calculator for dialysis patients, specific pathways for initiating, withholding and withdrawing dialysis, pain and symptom assessment scoring systems, and links to many web-based resources. While this app does not store data, it does offer the ability to compile the work done into a PDF suitable for uploading or printing and scanning for storage in paper or electronic charts.

It is provided free of charge for the iPad via the iTunes store  Funding to support app development was provided by DaVita.

The full guideline may be downloaded at