Factors influencing dialysis withdrawal: a scoping review

Abstract

BackgroundResearch on factors associated with dialysis withdrawal is scarce. This study examined the predictors that might influence rate of dialysis withdrawal. Existing literature is summarized, analyzed and synthesized to identify gaps in the literature with regard to the factors associated with dialysis withdrawal.MethodsThis scoping review used a systematic search to synthesize research findings related to dialysis withdrawal and identified gaps in the literature. The search strategy was developed and applied using PubMed, EMBASE and CINHAL databases. The selection criteria included articles written in English and published between 1997 and 2016 that examined dialysis withdrawal and associated factors in patients with any modality of renal dialysis.. Case reports and studies only including renal transplant patients were excluded. Fifteen articles were selected in accordance with these selection criteria.ResultsThe literature review revealed a scarcity of research on dialysis withdrawal and associated factors. Furthermore, the study findings were inconsistent and inconclusive. Authors have defined dialysis withdrawal in terms of dialysis discontinuation, withholding, death, withdrawal, treatment refusal/cessation, or technique failure. Authors have selected homogeneous patient population on either hemodialysis (HD) or peritoneal dialysis (PD) patients, thus making comparisons of studies and generalization of findings difficult.ConclusionFuture studies should explore the influence of both HD and PD on patient-elected dialysis withdrawal using a large a priori calculated sample size.Electronic supplementary materialThe online version of this article (10.1186/s12882-018-0894-5) contains supplementary material, which is available to authorized users.

Factors Associated With Dialysis Withdrawal In Dialysis Patients

“…Despite the higher prevalence of dialysis withdrawal and its significant association with death in ESRD patients, the phenomenon of dialysis withdrawal remains unclear [17]. There is a gap in the literature with regards to factors associated with dialysis withdrawal, mainly because of the scarcity of available literature and inconsistent findings across various studies [17].…”

“…These contradictory and inconsistent findings might be account for in several ways. Authors have defined dialysis withdrawal as withdrawal due to different reasons and causes, such as discontinuation, withholding, treatment refusal by patients and caregivers, and technique failure [10][11][12][13][14][15][16][17]. Some studies have used small sample sizes, resulting in type II error (false negative) [10,11], and some have not addressed mental health factors, such as depression/anxiety, dementia, and bipolar disorder [18] related to dialysis withdrawal.…”

Unique palliative care needs of patients with advanced chronic kidney disease – the scope of the problem and several solutions

“…There are more than 120,000 and 700,000 people with CKD5 in the UK and USA, respectively. 2 Over the past 60 years, the dialysis population has transitioned from a relatively healthy 'single-disease' population of patients to a population with many chronic diseases and, therefore, a high burden of associated symptoms. Dialysis has transitioned from a bridge to transplant to destination therapy for many patients who will not be eligible for transplant.…”

Factors Related to Duration of Dialysis Among Sudanese Patients on Hemodialysis at Gezira Hospital for Renal Diseases and Surgery, Gezira State, Sudan; 2018

“…it decreases as the quality of life improved [4]. The rate of withdrawal of dialysis is higher among women compared to men, and older patients compare to younger [5]. Male gender is negatively associated with withdrawal of heamodialysis.…”

“…Male gender is negatively associated with withdrawal of heamodialysis. There is no relation between withdrawal of hemodialysis and income, level of education, employment, and marital status [5]. A study carried out among patients on heamodialysis in Saudi, revealed that the mean age of the respondents is 51.7 years (± 15.4).…”