Prognostication After Dialysis Withdrawal

Abstract

IntroductionDialysis withdrawal represents an increasingly common cause of death in patients receiving kidney replacement therapy internationally. Prognostic information around stopping dialysis guides clinicians counselling patients and families regarding end-of-life care. However, few studies examine prognostication after withdrawal.We aimed to determine median survival time after withdrawal of dialysis, and to determine what patient and dialysis-related factors are significantly associated with prognosis. MethodsThis retrospective cohort study used registry data. We included all adult patients from the Western Renal Services who were receiving peritoneal dialysis or haemodialysis prior to death, whose cause of death was documented as “Withdrawal from dialysis” and whose date of death was between 1 January 2016 and 30 June 2022. Demographic, clinical and biochemical data was extracted. The primary outcome was time to death, defined as days from last dialysis session to date of death. ResultsMedian survival time from last dialysis to death for the peritoneal dialysis group (n=53) was 4 days (IQR 3-10 days), not significantly different from the haemodialysis group which was 6 days (IQR 2-11 days, p=0.72). For peritoneal dialysis, the only variable significantly associated with survival time was reason for withdrawing (p=0.01). Median survival time was significantly longer for patients withdrawing for psychosocial reasons compared to those withdrawing for other reasons (p=0.002). For haemodialysis (n=186), variables significantly associated with survival time from last dialysis to death was reason for withdrawing (p=0.001), urine production at time of withdrawal (p=0.005), serum sodium (p=0.02) and smoking status (p=0.009). ConclusionMedian survival time was longer for withdrawals for psychosocial reasons compared to medical reasons. The data presented could inform withdrawal discussions regarding prognostication and end-of-life planning with patients and family.