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
Highlights
There is an escalated risk of end-stage renal disease (ESRD) in the elderly in part due to the physiologic decline of kidney function related to aging, as well as the high prevalence of concurrent comorbidities such as diabetes and hypertension.[1–3] among patients with advanced chronic kidney disease (CKD), incidence rates of dialysis initiation are highest among those ≥75 years of age, with a three-fold higher risk compared to those in younger age groups (i.e., 45-64 years of age).[4, 5] there is added complexity in administering dialysis treatment to elderly patients, given their high comorbidity burden, frail status, and short life expectancy.[6]
Among patients ≥80 years, factors associated with higher odds of dialysis withdrawal included nonHispanic white ethnicity, having Medicare/Medicaid insurance, dementia, mid-west geographic region, and less favorable markers associated with malnutrition-inflammation-cachexia syndrome (MICS) such as high white blood cell counts and low body mass index, albumin, and normalized protein catabolic rate
Among patients ≥80 years of age, the withdrawal from hemodialysis group tended to be older and were more likely to be non-Hispanic white; have Medicare/Medicaid as their primary insurance; initiate dialysis with a central venous catheter; have diabetes, cardiac disease, or dementia; and have less favorable nutritional and inflammatory profiles at hemodialysis initiation based on laboratory surrogates
Summary
There is an escalated risk of end-stage renal disease (ESRD) in the elderly in part due to the physiologic decline of kidney function related to aging, as well as the high prevalence of concurrent comorbidities such as diabetes and hypertension.[1–3] among patients with advanced chronic kidney disease (CKD), incidence rates of dialysis initiation are highest among those ≥75 years of age, with a three-fold higher risk compared to those in younger age groups (i.e., 45-64 years of age).[4, 5] there is added complexity in administering dialysis treatment to elderly patients, given their high comorbidity burden, frail status, and short life expectancy.[6]. There is an escalated risk of end-stage renal disease (ESRD) in the elderly in part due to the physiologic decline of kidney function related to aging, as well as the high prevalence of concurrent comorbidities such as diabetes and hypertension.[1–3]. Among patients with advanced chronic kidney disease (CKD), incidence rates of dialysis initiation are highest among those ≥75 years of age, with a three-fold higher risk compared to those in younger age groups (i.e., 45-64 years of age).[4, 5]. There has been sparse study of the management of ESRD patients in the very-elderly age range (i.e., ⩾80 years), and there remains considerable uncertainty regarding the optimal approach to dialysis care in this population. Examining the factors associated with withdrawal from dialysis among patients age ≥80 years who have initiated hemodialysis may be relevant given the high incidence of ESRD in this population.[9–11]. United States Renal Data System (USRDS) data has shown that the proportion of deaths due to withdrawal from dialysis increased from 19% to nearly 25% from 1994 to 2007, respectively, and is the third leading cause of death among dialysis patients, following cardiovascular and infectious etiologies.[7, 8] Examining the factors associated with withdrawal from dialysis among patients age ≥80 years who have initiated hemodialysis may be relevant given the high incidence of ESRD in this population.[9–11] In the current study, we sought to determine the characteristics associated with withdrawal from hemodialysis in particular for the elderly ESRD population of age 80 years
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
