Withdrawal from dialysis: a review with an emphasis on the black experience

Withdrawal from dialysis has been shown to be a common occurrence in treated end-stage renal disease. Interestingly, there have been several reports documenting that blacks withdraw from dialysis one half to one third the rate of whites. There has been little research into the reasons for this marked discrepancy. This article reviews the existing literature on the different rates of withdrawal in blacks compared with whites. It then draws on a broad range of literature, including sociology, psychiatry, and anthropology, to propose possible reasons for the differences. From this review, it would seem that both medical and cultural factors play important roles in the decisions about withdrawal, but that cultural beliefs and attitudes are more important. More research is needed in both the medical and cultural aspects of rates of withdrawal to help explain the observed differences in blacks compared with whites.