TY - JOUR
T1 - Factors Associated With Withdrawal From Dialysis Therapy in Incident Hemodialysis Patients Aged 80 Years or Older
AU - Ko, Gang Jee
AU - Obi, Yoshitsugu
AU - Chang, Tae Ik
AU - Soohoo, Melissa
AU - Eriguchi, Rieko
AU - Choi, Soo Jeong
AU - Gillen, Daniel L.
AU - Kovesdy, Csaba P.
AU - Streja, Elani
AU - Kalantar-Zadeh, Kamyar
AU - Rhee, Connie M.
N1 - Funding Information:
This work is supported by the National Institute of Health/National Institute of Diabetes and Digestive and Kidney Disease (NIH/NIDDK)grant K24-DK091419 (KKZ)and philanthropic grants from Mr Harold Simmons, Mr Louis Chang, and Dr Joseph Lee. Y. Obi is supported by the Uehara Memorial Foundation Research Fellowship. E. Streja is supported by a career development award from the Office of Research and Development of the Department of Veterans Affairs, United States (IK2-CX001266-01). C.P. Kovesdy and K. Kalantar-Zadeh are supported by the NIH/NIDDK grant U01-DK102163. C.M. Rhee is supported by the NIH/NIDDK grants K23-DK102903 and R03-DK114642. We thank DaVita Clinical Research for providing the clinical data for this study.
Funding Information:
This work is supported by the National Institute of Health / National Institute of Diabetes and Digestive and Kidney Disease (NIH/NIDDK) grant K24-DK091419 (KKZ) and philanthropic grants from Mr Harold Simmons, Mr Louis Chang, and Dr Joseph Lee. Y. Obi is supported by the Uehara Memorial Foundation Research Fellowship. E. Streja is supported by a career development award from the Office of Research and Development of the Department of Veterans Affairs , United States (IK2-CX001266-01). C.P. Kovesdy and K. Kalantar-Zadeh are supported by the NIH / NIDDK grant U01 -DK102163 . C.M. Rhee is supported by the NIH / NIDDK grants K23-DK102903 and R03-DK114642 .
Publisher Copyright:
© 2018 AMDA – The Society for Post-Acute and Long-Term Care Medicine
PY - 2019/6
Y1 - 2019/6
N2 - 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.
AB - 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.
KW - Withdrawal from hemodialysis
KW - hemodialysis
KW - mortality
KW - very-elderly
UR - http://www.scopus.com/inward/record.url?scp=85060465313&partnerID=8YFLogxK
U2 - 10.1016/j.jamda.2018.11.030
DO - 10.1016/j.jamda.2018.11.030
M3 - Article
C2 - 30692035
AN - SCOPUS:85060465313
SN - 1525-8610
VL - 20
SP - 743-750.e1
JO - Journal of the American Medical Directors Association
JF - Journal of the American Medical Directors Association
IS - 6
ER -