Patients with chronic kidney disease are required to make difficult decisions, negotiating between the risks, burdens and benefits for any proposed course. This process can be extremely challenging, since these decisions involve inherent risks, which can impact on survival and quality of life. Shared decision‐making offers a patient‐centred approach in partnering with patients to make decisions about their treatment, which reflect their values and preferences. Shared decision‐making can improve patient preparedness, motivation, satisfaction, and adherence to the treatment or decision agreed upon. In this review article, we outline the key principles of shared decision‐making, and provide a framework with communication strategies to facilitate shared decision‐making. We highlight the broad range and context of decisions faced by patients in several areas of nephrology care and discuss patient‐important outcomes, priorities and motivations that underpin their decision‐making. Preserving patient autonomy through shared decision‐making ensures close consideration of patient preferences to enhance satisfaction with the decision reached and optimize outcomes important to patients.