Death after withdrawal from dialysis: the most common cause of death in a French dialysis population

Birmelé, Béatrice; François, Maud; Pengloan, J; Français, Patrick; Testou, Didier; Brillet, Georges; Lechapois, Didier; Baudin, Serge; Grezard, O.; Jourdan, Jean Louis; Fodil-Cherif, Mohamed; Abaza, M. A.; Dupouet, L; Fournier, Gilles; Nivet, Hubert

doi:10.1093/ndt/gfg606

Cited by 79 publications

(92 citation statements)

References 16 publications

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“…This finding is in contrast to those of other studies, which found that dialysis modality had no effect on DW (17,23). The effect of modality was strong and persisted even after adjustment for confounders.…”

Section: Discussioncontrasting

confidence: 94%

“…Some studies showed an increase in DW among women (4), whereas others showed no significant sex difference in the rate of DW (11,17). In our study, women were more likely to withdraw from dialysis than men.…”

Section: Discussioncontrasting

confidence: 48%

“…Some reports showed that diabetes mellitus is associated with higher rates of DW (4,9,10,13), whereas other studies showed no significant difference (14,17,19). Our study revealed that diabetic status was associated with an increased risk for DW.…”

Section: Discussionmentioning

confidence: 98%

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Risk Factors for Dialysis Withdrawal

Chan

Clayton

McDonald

et al. 2012

Clinical Journal of the American Society of Nephrology

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Summary Background and objectives Dialysis withdrawal (DW) in patients with ESRD is increasing in importance. This study assessed causes of death and risk factors for DW in Australia and New Zealand in the first year of dialysis. Design, setting, participants, & measurements This retrospective observational cohort study included all adult Australians and New Zealanders beginning renal replacement therapy in 1999–2008. Results A total of 24,884 patients with 10,073 deaths were included. Deaths from cardiac and social causes (predominantly DW) accounted for 38% and 28% of all deaths, respectively. Cumulative incidence of DW was 3.5% at 1 year (95% confidence interval [CI], 3.3%–3.8%), 9.0% at 3 years (95% CI, 8.6%–9.4%), and 13.4% at 5 years (95% CI, 12.8%–13.9%). In multivariate analysis, predictors for DW in the first year were older age (subhazard ratio [SHR], 1.70 per decade [95% CI, 1.59–1.83]; P<0.001), late referral (SHR, 1.83 [95% CI, 1.59–2.11]; P<0.001), comorbid conditions (SHR, 1.33 per each additional comorbid condition [95% CI, 1.25–1.41]; P<0.001), and diabetes (SHR, 1.16 [95% CI, 1.00–1.34]; P=0.05). Negative predictors for DW included male sex (SHR, 0.75 [95% CI, 0.66–0.87]; P<0.001), indigenous ethnicity (SHR, 0.74 [95% CI, 0.58–0.95]; P=0.02), other nonwhite race (SHR, 0.66 [95% CI, 0.48–0.91]; P=0.01), and peritoneal dialysis user (SHR, 0.59 [95% CI, 0.49–0.72]; P<0.001). Conclusions DW is common among dialysis patients in Australia and New Zealand. Risk factors include older age, female sex, white race, diabetes, higher comorbidity burden, hemodialysis user, and late referral to nephrologist.

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Section: Discussioncontrasting

confidence: 94%

Section: Discussioncontrasting

confidence: 48%

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Risk Factors for Dialysis Withdrawal

Chan

Clayton

McDonald

et al. 2012

Clinical Journal of the American Society of Nephrology

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“…Munshi and colleagues (2001) report that withdrawal from treatment precedes death for 38% of U.S. dialysis patients over age 75. Discontinuation from dialysis is also reported as the first or second most common cause of death among patients in the U.K., Australia, and France, though it appears to be less common elsewhere in Europe and Japan (Sehgal, 1996;White & Fitzpatrick, 2006); variation could stem from disparate reporting methods for dialysis withdrawal in different countries and centers (Birmele, Francois, Pengloan, Francais, Testou, Brillet, et al, 2004). For those who stop, death usually comes within a matter of weeks or days.…”

Section: The Emergence Of Geriatric Dialysismentioning

confidence: 99%

The value of “life at any cost”: Talk about stopping kidney dialysis

Russ

Shim

Kaufman

2007

Social Science & Medicine

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With the trend toward an older, sicker dialysis population in the USA, discussions of ethical issues surrounding dialysis have shifted from concerns about access to and availability of the therapy, to growing unease about non-initiation and treatment discontinuation. Recent studies report treatment withdrawal as the leading cause of death among elderly dialysis patients. Yet, the actual activities that move patients toward stopping treatment often remain obscure, even to clinicians and patients themselves. This paper explores that paradox, drawing on anthropological research among patients over age 70, their families, and clinicians in two California renal dialysis units. It concludes that many older patients sacrifice a sense of choice about dialysis in the present to maintain "choice" as both value and possibility for the future. Yet, patients desire more information and communication, provided earlier in their illness, about prognosis, how long they can expect to be on dialysis, and what the impact of the treatment will be on their daily lives. That, with time, there is a transition to be made from dialysis as "treatment" to end of life care could be better explained and managed to alleviate patients' confusion and unneeded isolation.

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“…In a French study, 196 of 1,436 dialysis patients died during follow-up. 25 The single most common cause of death was dialysis withdrawal (defined as death occurring more than three days since the last dialysis), which accounted for no fewer than 20% of all deaths. Mean survival time after the last treatment session was 8.5 days (median seven days).…”

Section: Dialysis Withdrawalmentioning

confidence: 99%

The challenges of renal replacement therapy and renal palliative care in the elderly

Isles¹,

Robertson²,

Almond³

et al. 2011

J R Coll Physicians Edinb

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The main aim of this review is to let general practitioners and physicians understand what happens to older patients after referral to the renal service. Usually, most patients will be managed completely by the renal team, either because the patient requires dialysis or because conservative but specialised care is appropriate. The recent increase in dialysis rate can mostly be accounted for by older patients for whom such demanding treatment was previously thought to be contraindicated. The decision to dialyse the elderly still remains difficult, with recent data suggesting that if there are significant comorbidities the survival advantage of dialysis in patients over 75 years of age is unlikely to be more than four months. Towards the end of life, conservative treatment is not simply a decision not to dialyse, but comprises active disease management, including treatment of anaemia and other supportive care, which may become increasingly complex, e.g. pain relief with fentanyl and alfentanyl. Older patients who decide to accept dialysis treatment contend with all the usual end of life issues of older people. They have an additional option, denied to the rest of us, of dialysis withdrawal; this effectively allows them to die at a time of their choosing.

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Death after withdrawal from dialysis: the most common cause of death in a French dialysis population

Cited by 79 publications

References 16 publications

Risk Factors for Dialysis Withdrawal

Risk Factors for Dialysis Withdrawal

The value of “life at any cost”: Talk about stopping kidney dialysis

The challenges of renal replacement therapy and renal palliative care in the elderly

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