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This paper aims to identify the reasons for choosing or refusing kidney transplantation as renal replacement therapy among patients with Chronic Kidney Disease (CKD). Data were collected through interviews with CKD patients treated by dialysis. Health professionals were also interviewed. A thematic analysis was used to analyze the data. Results show that various reasons account for CKD patients’ refusal to have a kidney transplant: the perception of kidney transplantation as a renal replacement therapy without positive outcome, refusal to have an allograft. There are also situations such as the lack of organ, the age factor, the contraindications to kidney transplantation that not allow some CKD patients to have a kidney transplant. Among the patients who choose kidney transplantation, some insist on the high level of health literacy, others see kidney transplantation as a cure or a normal process. Ultimately, this paper shows that the choice of kidney transplantation depends on patients’ perceptions of its outcomes. Some circumstances, such as the lack of an available organ or specific medical criteria, reduce CKD patients’ participation in the decision-making process.