Factors Associated With Withdrawal From Dialysis Therapy in Incident Hemodialysis Patients Aged 80 Years or Older

Gang Jee Ko, Yoshitsugu Obi, Tae Ik Chang, Melissa Soohoo, Rieko Eriguchi, Soo Jeong Choi, Daniel L. Gillen, Csaba P. Kovesdy, Elani Streja, Kamyar Kalantar-Zadeh, Connie M. Rhee

    Research output: Contribution to journalArticlepeer-review

    13 Citations (Scopus)


    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.

    Original languageEnglish
    Pages (from-to)743-750.e1
    JournalJournal of the American Medical Directors Association
    Issue number6
    Publication statusPublished - 2019 Jun

    Bibliographical note

    Publisher Copyright:
    © 2018 AMDA – The Society for Post-Acute and Long-Term Care Medicine


    • Withdrawal from hemodialysis
    • hemodialysis
    • mortality
    • very-elderly

    ASJC Scopus subject areas

    • General Nursing
    • Health Policy
    • Geriatrics and Gerontology


    Dive into the research topics of 'Factors Associated With Withdrawal From Dialysis Therapy in Incident Hemodialysis Patients Aged 80 Years or Older'. Together they form a unique fingerprint.

    Cite this