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Published on: November 12, 2014
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Factors Associated With Withdrawal From Maintenance Dialysis: A Case-Control Analysis
James B Wetmore1, Heng Yan2, Yan Hu2
1Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN; Division of Nephrology, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN.
Summary
Older women and white patients were more likely to withdraw from dialysis. The period before withdrawal saw increased medical events and morbidity, highlighting a critical care transition.
Area of Science:
- Nephrology
- Geriatrics
- Public Health
Background:
- Understanding patient withdrawal from dialysis is crucial for care planning.
- Limited data exists on the clinical course differences between dialysis withdrawal and continuation.
Purpose of the Study:
- To identify predictors of dialysis withdrawal.
- To characterize the clinical course preceding dialysis withdrawal.
Main Methods:
- A case-control analysis of US Medicare patients on maintenance hemodialysis for over a year (2008-2011).
- Examined predictors including comorbid conditions, hospitalizations, skilled nursing facility stays, and a morbidity score.
- Outcome was withdrawal from dialysis therapy.
Main Results:
- Older age, female sex, and white race were associated with higher odds of dialysis withdrawal.
- Higher morbidity scores, particularly those derived from durable medical equipment claims, strongly predicted withdrawal.
- Medical events, hospitalizations, and morbidity scores increased in the months leading up to dialysis withdrawal.
Conclusions:
- Demographic factors like age, sex, and race influence dialysis withdrawal decisions.
- Increased morbidity and healthcare utilization precede dialysis withdrawal, indicating a decline in patient health status.
- These findings underscore the need for proactive care and support during end-of-life transitions for dialysis patients.
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