Factors Associated With Withdrawal From Dialysis Therapy in Incident Hemodialysis Patients Aged 80 Years or Older |
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Authors: | 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 |
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Institution: | 1. Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA;2. Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea;3. Department of Internal Medicine, NHIS Medical Center, Ilsan Hospital, Goyang, Korea;4. Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon Hospital, Buchoen, Korea;5. Nephrology section, University of Tennessee Health Science Center, Memphis, TN;6. Nephrology section, Memphis Veterans Affairs Medical Center, Memphis, TN;7. Department of Medicine, Long Beach Veteran Affairs Health System, Long Beach, CA;8. Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA |
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Abstract: | ObjectivesAmong 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 designHistorical cohort study.Setting and participantsWe examined 133,162 incident hemodialysis patients receiving care within a large national dialysis organization from 2007 to 2011.MeasuresWe 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.ResultsAmong 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/ImplicationsAmong 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 |
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Keywords: | Address correspondence to Kamyar Kalantar-Zadeh MD MPH PhD Department of Medicine Pediatrics & Public Health Harold Simmons Center for Kidney Disease Research and Epidemiology Division of Nephrology & Hypertension University of California Irvine (UCI) School of Medicine 101 The City Drive South City Tower Suite 400-ZOT: 4088 Orange CA 92868-3217 Withdrawal from hemodialysis very-elderly mortality hemodialysis |
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