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

Abstract

Objectives: Among very-elderly kidney disease patients progressing to end-stage renal disease, there is growing interest in conservative non-dialytic 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.

Comparative Analysis of Efficacy and Prognosis of Hemodialysis and Peritoneal Dialysis for End-Stage Renal Disease: A Meta-analysis

“…At the same time, some substances have toxic effects, resulting in lesions in the digestive system, heart, and lung and causing decreased immunity and high probability of complicating infection [ 7 ]. Most uremic patients are in a microinflammatory state, and microinflammatory response has been reported to be closely associated with the progression and complications of ESRD and even the death of uremic patients [ 8 , 9 ].…”

Changing landscape of dialysis withdrawal in patients with kidney failure: Implications for clinical practice

“…The main outcomes examined are temporal trends and risk factors for dialysis withdrawal which have implications on recourse allocation and healthcare strategies. On the other hand, single‐ and multi‐centre studies often define dialysis withdrawal as death from kidney failure after discontinuation of dialysis, excluding patients who withdraw dialysis for other terminal medical conditions 1,37–42 . These studies aim to differentiate psychosocial details and to assess the experience of dialysis withdrawal.…”

“…On the other hand, single-and multi-centre studies often define dialysis withdrawal as death from kidney failure after discontinuation of dialysis, excluding patients who withdraw dialysis for other terminal medical conditions. 1,[37][38][39][40][41][42] These studies aim to differentiate psychosocial details and to assess the experience of dialysis withdrawal. The inconsistent definitions between national registries and research studies likely included patients with different underlying phenotypes.…”

Ethical Challenges When Caring for African American Older Adults Requesting to Withdraw From Dialysis

“…The high symptom burden, morbidity, and mortality in older adults receiving dialysis may lead to withdrawal from maintenance HD as requested by the individual or family. Regardless of race, factors that contribute to the decision to withdraw from HD include having chronic kidney disease–associated pruritus, 8 being recently hospitalized (within 30 days), experiencing frailty, 9 and having biomarkers indicating malnutrition-inflammation-cachexia syndrome (high white blood cell count, low body mass index, low serum albumin, and low normalized protein catabolic rate) 10 . Other factors related to withdrawal are age (≥70 years), diabetes as the cause for ESKD, renovascular disease, receiving in-center HD, and length of dialysis (time from the first dialysis treatment to present) 11 .…”

“…Regardless of race, factors that contribute to the decision to withdraw from HD include having chronic kidney disease-associated pruritus, 8 being recently hospitalized (within 30 days), experiencing frailty, 9 and having biomarkers indicating malnutrition-inflammation-cachexia syndrome (high white blood cell count, low body mass index, low serum albumin, and low normalized protein catabolic rate). 10 Other factors related to withdrawal are age (≥70 years), diabetes as the cause for ESKD, renovascular disease, receiving in-center HD, and length of dialysis (time from the first dialysis treatment to present). 11 There are several things to consider before responding to a patient's request to withdraw from dialysis, such as ethical principles of stopping a life-sustaining treatment.…”