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 Kovesdy, Elani Streja, Kamyar Kalantar-Zadeh, Connie M. Rhee

Research output: Contribution to journalArticle

Abstract

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. Further studies examining implications of withdrawal from dialysis in older patients are warranted

Original languageEnglish (US)
Pages (from-to)743-750.e1
JournalJournal of the American Medical Directors Association
Volume20
Issue number6
DOIs
StatePublished - Jun 1 2019

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Renal Dialysis
Dialysis
Therapeutics
Cause of Death
Cachexia
Central Venous Catheters
Arteriovenous Fistula
Kidney Diseases
Nutritional Status
Leukocyte Count
Malnutrition
Chronic Kidney Failure
Blood Vessels
Dementia
Albumins
Patient Care
Body Mass Index
Cohort Studies
Age Groups
Logistic Models

All Science Journal Classification (ASJC) codes

  • Nursing(all)
  • Health Policy
  • Geriatrics and Gerontology

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Factors Associated With Withdrawal From Dialysis Therapy in Incident Hemodialysis Patients Aged 80 Years or Older. / Ko, Gang Jee; Obi, Yoshitsugu; Chang, Tae Ik; Soohoo, Melissa; Eriguchi, Rieko; Choi, Soo Jeong; Gillen, Daniel L.; Kovesdy, Csaba; Streja, Elani; Kalantar-Zadeh, Kamyar; Rhee, Connie M.

In: Journal of the American Medical Directors Association, Vol. 20, No. 6, 01.06.2019, p. 743-750.e1.

Research output: Contribution to journalArticle

Ko, GJ, Obi, Y, Chang, TI, Soohoo, M, Eriguchi, R, Choi, SJ, Gillen, DL, Kovesdy, C, Streja, E, Kalantar-Zadeh, K & Rhee, CM 2019, 'Factors Associated With Withdrawal From Dialysis Therapy in Incident Hemodialysis Patients Aged 80 Years or Older', Journal of the American Medical Directors Association, vol. 20, no. 6, pp. 743-750.e1. https://doi.org/10.1016/j.jamda.2018.11.030
Ko, Gang Jee ; Obi, Yoshitsugu ; Chang, Tae Ik ; Soohoo, Melissa ; Eriguchi, Rieko ; Choi, Soo Jeong ; Gillen, Daniel L. ; Kovesdy, Csaba ; Streja, Elani ; Kalantar-Zadeh, Kamyar ; Rhee, Connie M. / Factors Associated With Withdrawal From Dialysis Therapy in Incident Hemodialysis Patients Aged 80 Years or Older. In: Journal of the American Medical Directors Association. 2019 ; Vol. 20, No. 6. pp. 743-750.e1.
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AU - Ko, Gang Jee

AU - Obi, Yoshitsugu

AU - Chang, Tae Ik

AU - Soohoo, Melissa

AU - Eriguchi, Rieko

AU - Choi, Soo Jeong

AU - Gillen, Daniel L.

AU - Kovesdy, Csaba

AU - Streja, Elani

AU - Kalantar-Zadeh, Kamyar

AU - Rhee, Connie M.

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