Gang Jee Ko1, Yoshitsugu Obi2, Tae Ik Chang3, Melissa Soohoo2, Rieko Eriguchi2, Soo Jeong Choi4, Daniel L Gillen2, Csaba P Kovesdy5, Elani Streja2, Kamyar Kalantar-Zadeh6, Connie M Rhee2. 1. Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA; Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea. 2. Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA. 3. Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA; Department of Internal Medicine, NHIS Medical Center, Ilsan Hospital, Goyang, Korea. 4. Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA; Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon Hospital, Buchoen, Korea. 5. Nephrology section, University of Tennessee Health Science Center, Memphis, TN; Nephrology section, Memphis Veterans Affairs Medical Center, Memphis, TN. 6. Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA; Department of Medicine, Long Beach Veteran Affairs Health System, Long Beach, CA; Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA. Electronic address: kkz@uci.edu.
Abstract
OBJECTIVES: Among kidney disease patients ≥80 years progressing to end-stage renal disease, there is growing interest in conservative nondialytic management approaches. However, among those who have initiated hemodialysis, little is known about the impact of withdrawal from dialysis on mortality, nor the patient characteristics associated with withdrawal from dialysis. STUDY DESIGN: Historical cohort study. SETTING AND PARTICIPANTS: We examined 133,162 incident hemodialysis patients receiving care within a large national dialysis organization from 2007 to 2011. MEASURES: We identified patients who withdrew from dialysis, either as a listed cause of death or censor reason. Incidence rates and subdistribution hazard ratios for withdrawal from dialysis as well as 4 other censoring reasons were examined across age groups. In addition, demographic and clinical characteristics associated with withdrawal from dialysis therapy among patients ≥80 years old was assessed using logistic regression analysis. RESULTS: Among 17,296 patients aged ≥80 years, 10% of patients withdrew from dialysis. Duration from the last hemodialysis treatment to death was 10 [interquartile range 6-16] days in patients with available data. Withdrawal from dialysis was the second and third most common cause of death among patients aged ≥80 years and <80 years, respectively. Among patients ≥80 years, minorities were much less likely than non-Hispanic whites to stop dialysis. Other factors associated with higher odds of dialysis withdrawal included having a central venous catheter compared to an arteriovenous fistula at dialysis start, dementia, living in mid-west regions, and less favorable markers associated with malnutrition-inflammation-cachexia syndrome such as higher white blood cell counts and lower body mass index, albumin, and normalized protein catabolic rate. CONCLUSION/IMPLICATIONS: Among very-elderly incident hemodialysis patients, dialysis therapy withdrawal exhibits wide variations across age, race and ethnicity, regions, cognitive status, dialysis vascular access, and nutritional status. Further studies examining implications of withdrawal from dialysis in older patients are warranted.
OBJECTIVES: Among kidney diseasepatients ≥80 years progressing to end-stage renal disease, there is growing interest in conservative nondialytic management approaches. However, among those who have initiated hemodialysis, little is known about the impact of withdrawal from dialysis on mortality, nor the patient characteristics associated with withdrawal from dialysis. STUDY DESIGN: Historical cohort study. SETTING AND PARTICIPANTS: We examined 133,162 incident hemodialysis patients receiving care within a large national dialysis organization from 2007 to 2011. MEASURES: We identified patients who withdrew from dialysis, either as a listed cause of death or censor reason. Incidence rates and subdistribution hazard ratios for withdrawal from dialysis as well as 4 other censoring reasons were examined across age groups. In addition, demographic and clinical characteristics associated with withdrawal from dialysis therapy among patients ≥80 years old was assessed using logistic regression analysis. RESULTS: Among 17,296 patients aged ≥80 years, 10% of patients withdrew from dialysis. Duration from the last hemodialysis treatment to death was 10 [interquartile range 6-16] days in patients with available data. Withdrawal from dialysis was the second and third most common cause of death among patients aged ≥80 years and <80 years, respectively. Among patients ≥80 years, minorities were much less likely than non-Hispanic whites to stop dialysis. Other factors associated with higher odds of dialysis withdrawal included having a central venous catheter compared to an arteriovenous fistula at dialysis start, dementia, living in mid-west regions, and less favorable markers associated with malnutrition-inflammation-cachexia syndrome such as higher white blood cell counts and lower body mass index, albumin, and normalized protein catabolic rate. CONCLUSION/IMPLICATIONS: Among very-elderly incident hemodialysis patients, dialysis therapy withdrawal exhibits wide variations across age, race and ethnicity, regions, cognitive status, dialysis vascular access, and nutritional status. Further studies examining implications of withdrawal from dialysis in older patients are warranted.
Authors: Rachel B Fissell; Jennifer L Bragg-Gresham; Antonio Alberto Lopes; José Miguel Cruz; Shunichi Fukuhara; Yasushi Asano; Wendy Weinstock Brown; Marcia L Keen; Friedrich K Port; Eric W Young Journal: Kidney Int Date: 2005-09 Impact factor: 10.612
Authors: Mathijs van Oevelen; Alferso C Abrahams; Willem Jan W Bos; Tiny Hoekstra; Marc H Hemmelder; Marc Ten Dam; Marjolijn van Buren Journal: Nephrol Dial Transplant Date: 2021-11-09 Impact factor: 5.992