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Withdrawal from dialysis therapy higher in women, older patients, white patients
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Women, older patients and white patients were more likely to withdraw from dialysis therapy, according to a study published in the American Journal of Kidney Diseases. Further, the period before withdrawal correlated with higher rates of medical events and higher levels of morbidity.
"Elective withdrawal from dialysis is an increasingly important care option,” study co-author James B. Wetmore, MD, MS, medical director for nephrology research at the Chronic Disease Research Group, told Healio Nephrology. “Many epidemiologic studies examined predictors of withdrawal based on characteristics of patients when they started dialysis; however, we thought that novel insights could be garnered by starting at the time of withdrawal and then looking back at events that preceded elective withdrawal.”
Between Jan. 1, 2008, and Dec. 31, 2011, Wetmore and colleagues conducted a case-control study of 18,367 patients who withdrew from hemodialysis therapy and 220,443 who did not . Researchers included patients who received hemodialysis for at least 1 year. To eliminate patients who faced imminent death and did not truly withdrawal, the researchers required death 1 more days after withdrawal.
“We matched patients who electively withdrew to patients who could have withdrawn, but who did not,” Wetmore said. “As might be expected, medical events, hospitalizations, and use of durable medical equipment – a potential sign of frailty – increased in the lead-up to withdrawal.”
According to the study, medical events assessed were hospitalizations for myocardial infarction, congestive heart failure, stroke, amputation/critical limb ischemia, sepsis, pneumonia, vascular access infection, gastrointestinal bleeding, or fracture.
The researchers found that certain patients had a higher risk for withdrawal from dialysis, even after adjusting for comorbidities that included diabetes, atherosclerotic heart disease, congestive heart failure, and others.
“The odds of withdrawal were about 7% higher in women than in men. More strikingly, members of racial and ethnic minorities were less than half as likely to withdraw as whites, even after adjustment for other factors such as comorbidities and use of medical equipment,” Wetmore said. “This striking difference in elective withdrawal by race may reflect cultural differences or how providers and the health care community interact with racial minorities when discussing the possibility of elective dialysis withdrawal, but more work to understand this phenomenon needs to be undertaken." – by Jake Scott
Disclosure: The authors reported no relevant financial disclosures.
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