BACKGROUND Hospital accreditation in Taiwan encourages greater use of shared decision making (SDM) in health care. This study aimed to explore the distribution change of treatment modalities for renal replacement therapy (RRT) before and after the use of SDM in newly diagnosed end-stage renal disease (ESRD) patients. METHODS The processes of SDM for RRT were designed with Internet-based patient educational program and smart system. The project of SDM was reviewed by departmental consensus meeting and continuously executed since January 2017. Patients received long-term RRT between January 2016 and December 2017 were enrolled. RESULTS In 2017, 310 patients (187 male, average 63.9 years old) received long-term RRT. Of them, 220 (71%) patients completed SDM for RRT. Sixty-six patients received peritoneal dialysis (PD), 67 patients entered the evaluation of living related kidney transplantation (KT) program, while 18 patients finally received operation for living KT. Compared to 2016, execution of SDM for RRT was associated with drastically increase of the number of living KT (38.5%) and PD (112.9%) after the implementation of SDM for RRT in 2017. The number of preemptive living KT was also increased from 1 patient to 5 patients. Moreover, 91.3% patients were satisfied with the process of SDM for RRT. CONCLUSIONS Our findings suggest that the implementation of SDM before patients entering long term RRT lead to more ESRD patients receiving living KT and entering PD therapy. The increasing trend of living KT could be reasonably expected if SDM for RRT could be carried out nationwide.