Factors influencing withdrawal from dialysis

a national registry study

Mark D. Findlay (Lead / Corresponding author), Ken Donaldson, Arthur Doyle, Jonathan G. Fox, Izhar Khan, Jackie McDonald, Wendy Metcalfe, Robert K. Peel, Ilona Shilliday, Elaine Spalding, Graham A. Stewart, Jamie P. Traynor, Bruce Mackinnon, on behalf of the Scottish Renal Registry (SRR)

    Research output: Contribution to journalArticle

    14 Citations (Scopus)

    Abstract

    BACKGROUND: Dialysis withdrawal is the third most common cause of death in patients receiving dialysis for established renal failure (ERF) in Scotland. We describe incidence, risk factors and themes influencing decision-making in a national renal registry.

    METHODS: Details of deaths in those receiving renal replacement therapy (RRT) for ERF in Scotland are reported to the Scottish Renal Registry via a unique mortality report. We extracted patient demographics and comorbidity, cause and location of death, duration of RRT and pertinent free text comments from 1 January 2008 to 31 December 2014. Withdrawal incidence was calculated and logistic regression used to identify significantly influential variables. Themes emerging from clinician comments were tabulated for descriptive purposes.

    RESULTS: There were 2596 deaths; median age at death was 68 [interquartile range (IQR) 58, 76] years, 41.5% were female. Median duration on RRT was 1110 (IQR 417, 2151) days. Dialysis withdrawal was the primary cause of death in 497 (19.1%) patients and withdrawal contributed to death in a further 442 cases (17.0%). The incidence was 41 episodes per 1000 patient-years. Regression analysis revealed increasing age, female sex and prior cerebrovascular disease were associated with dialysis withdrawal as a primary cause of death. Conversely, interstitial renal disease, angiographically proven ischaemic heart disease, valvular heart disease and malignancy were negatively associated. Analysis of free text comments revealed common themes, portraying an image of physical and psychological decline accelerated by acute illnesses.

    CONCLUSIONS: Death following dialysis withdrawal is common. Factors important to physical independence-prior cerebrovascular disease and increasing age-are associated with withdrawal. When combined with clinician comments this study provides an insight into the clinical decline affecting patients and the complexity of this decision. Early recognition of those likely to withdraw may improve end of life care.

    Original languageEnglish
    Pages (from-to)2041-2048
    Number of pages8
    JournalNephrology Dialysis Transplantation
    Volume31
    Issue number12
    Early online date21 Apr 2016
    DOIs
    Publication statusPublished - 21 Apr 2016

    Fingerprint

    Registries
    Dialysis
    Renal Replacement Therapy
    Cause of Death
    Cerebrovascular Disorders
    Scotland
    Kidney
    Renal Insufficiency
    Incidence
    Heart Valve Diseases
    Terminal Care
    Myocardial Ischemia
    Comorbidity
    Decision Making
    Logistic Models
    Regression Analysis
    Demography
    Psychology
    Mortality
    Neoplasms

    Cite this

    Findlay, M. D., Donaldson, K., Doyle, A., Fox, J. G., Khan, I., McDonald, J., ... on behalf of the Scottish Renal Registry (SRR) (2016). Factors influencing withdrawal from dialysis: a national registry study. Nephrology Dialysis Transplantation, 31(12), 2041-2048. https://doi.org/10.1093/ndt/gfw074
    Findlay, Mark D. ; Donaldson, Ken ; Doyle, Arthur ; Fox, Jonathan G. ; Khan, Izhar ; McDonald, Jackie ; Metcalfe, Wendy ; Peel, Robert K. ; Shilliday, Ilona ; Spalding, Elaine ; Stewart, Graham A. ; Traynor, Jamie P. ; Mackinnon, Bruce ; on behalf of the Scottish Renal Registry (SRR). / Factors influencing withdrawal from dialysis : a national registry study. In: Nephrology Dialysis Transplantation. 2016 ; Vol. 31, No. 12. pp. 2041-2048.
    @article{ba285e8bc81b4648852842d465a9323b,
    title = "Factors influencing withdrawal from dialysis: a national registry study",
    abstract = "BACKGROUND: Dialysis withdrawal is the third most common cause of death in patients receiving dialysis for established renal failure (ERF) in Scotland. We describe incidence, risk factors and themes influencing decision-making in a national renal registry.METHODS: Details of deaths in those receiving renal replacement therapy (RRT) for ERF in Scotland are reported to the Scottish Renal Registry via a unique mortality report. We extracted patient demographics and comorbidity, cause and location of death, duration of RRT and pertinent free text comments from 1 January 2008 to 31 December 2014. Withdrawal incidence was calculated and logistic regression used to identify significantly influential variables. Themes emerging from clinician comments were tabulated for descriptive purposes.RESULTS: There were 2596 deaths; median age at death was 68 [interquartile range (IQR) 58, 76] years, 41.5{\%} were female. Median duration on RRT was 1110 (IQR 417, 2151) days. Dialysis withdrawal was the primary cause of death in 497 (19.1{\%}) patients and withdrawal contributed to death in a further 442 cases (17.0{\%}). The incidence was 41 episodes per 1000 patient-years. Regression analysis revealed increasing age, female sex and prior cerebrovascular disease were associated with dialysis withdrawal as a primary cause of death. Conversely, interstitial renal disease, angiographically proven ischaemic heart disease, valvular heart disease and malignancy were negatively associated. Analysis of free text comments revealed common themes, portraying an image of physical and psychological decline accelerated by acute illnesses.CONCLUSIONS: Death following dialysis withdrawal is common. Factors important to physical independence-prior cerebrovascular disease and increasing age-are associated with withdrawal. When combined with clinician comments this study provides an insight into the clinical decline affecting patients and the complexity of this decision. Early recognition of those likely to withdraw may improve end of life care.",
    author = "Findlay, {Mark D.} and Ken Donaldson and Arthur Doyle and Fox, {Jonathan G.} and Izhar Khan and Jackie McDonald and Wendy Metcalfe and Peel, {Robert K.} and Ilona Shilliday and Elaine Spalding and Stewart, {Graham A.} and Traynor, {Jamie P.} and Bruce Mackinnon and {on behalf of the Scottish Renal Registry (SRR)}",
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    Findlay, MD, Donaldson, K, Doyle, A, Fox, JG, Khan, I, McDonald, J, Metcalfe, W, Peel, RK, Shilliday, I, Spalding, E, Stewart, GA, Traynor, JP, Mackinnon, B & on behalf of the Scottish Renal Registry (SRR) 2016, 'Factors influencing withdrawal from dialysis: a national registry study', Nephrology Dialysis Transplantation, vol. 31, no. 12, pp. 2041-2048. https://doi.org/10.1093/ndt/gfw074

    Factors influencing withdrawal from dialysis : a national registry study. / Findlay, Mark D. (Lead / Corresponding author); Donaldson, Ken; Doyle, Arthur; Fox, Jonathan G.; Khan, Izhar; McDonald, Jackie; Metcalfe, Wendy; Peel, Robert K.; Shilliday, Ilona; Spalding, Elaine; Stewart, Graham A.; Traynor, Jamie P.; Mackinnon, Bruce; on behalf of the Scottish Renal Registry (SRR).

    In: Nephrology Dialysis Transplantation, Vol. 31, No. 12, 21.04.2016, p. 2041-2048.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - Factors influencing withdrawal from dialysis

    T2 - a national registry study

    AU - Findlay, Mark D.

    AU - Donaldson, Ken

    AU - Doyle, Arthur

    AU - Fox, Jonathan G.

    AU - Khan, Izhar

    AU - McDonald, Jackie

    AU - Metcalfe, Wendy

    AU - Peel, Robert K.

    AU - Shilliday, Ilona

    AU - Spalding, Elaine

    AU - Stewart, Graham A.

    AU - Traynor, Jamie P.

    AU - Mackinnon, Bruce

    AU - on behalf of the Scottish Renal Registry (SRR)

    N1 - © The Author 2016. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

    PY - 2016/4/21

    Y1 - 2016/4/21

    N2 - BACKGROUND: Dialysis withdrawal is the third most common cause of death in patients receiving dialysis for established renal failure (ERF) in Scotland. We describe incidence, risk factors and themes influencing decision-making in a national renal registry.METHODS: Details of deaths in those receiving renal replacement therapy (RRT) for ERF in Scotland are reported to the Scottish Renal Registry via a unique mortality report. We extracted patient demographics and comorbidity, cause and location of death, duration of RRT and pertinent free text comments from 1 January 2008 to 31 December 2014. Withdrawal incidence was calculated and logistic regression used to identify significantly influential variables. Themes emerging from clinician comments were tabulated for descriptive purposes.RESULTS: There were 2596 deaths; median age at death was 68 [interquartile range (IQR) 58, 76] years, 41.5% were female. Median duration on RRT was 1110 (IQR 417, 2151) days. Dialysis withdrawal was the primary cause of death in 497 (19.1%) patients and withdrawal contributed to death in a further 442 cases (17.0%). The incidence was 41 episodes per 1000 patient-years. Regression analysis revealed increasing age, female sex and prior cerebrovascular disease were associated with dialysis withdrawal as a primary cause of death. Conversely, interstitial renal disease, angiographically proven ischaemic heart disease, valvular heart disease and malignancy were negatively associated. Analysis of free text comments revealed common themes, portraying an image of physical and psychological decline accelerated by acute illnesses.CONCLUSIONS: Death following dialysis withdrawal is common. Factors important to physical independence-prior cerebrovascular disease and increasing age-are associated with withdrawal. When combined with clinician comments this study provides an insight into the clinical decline affecting patients and the complexity of this decision. Early recognition of those likely to withdraw may improve end of life care.

    AB - BACKGROUND: Dialysis withdrawal is the third most common cause of death in patients receiving dialysis for established renal failure (ERF) in Scotland. We describe incidence, risk factors and themes influencing decision-making in a national renal registry.METHODS: Details of deaths in those receiving renal replacement therapy (RRT) for ERF in Scotland are reported to the Scottish Renal Registry via a unique mortality report. We extracted patient demographics and comorbidity, cause and location of death, duration of RRT and pertinent free text comments from 1 January 2008 to 31 December 2014. Withdrawal incidence was calculated and logistic regression used to identify significantly influential variables. Themes emerging from clinician comments were tabulated for descriptive purposes.RESULTS: There were 2596 deaths; median age at death was 68 [interquartile range (IQR) 58, 76] years, 41.5% were female. Median duration on RRT was 1110 (IQR 417, 2151) days. Dialysis withdrawal was the primary cause of death in 497 (19.1%) patients and withdrawal contributed to death in a further 442 cases (17.0%). The incidence was 41 episodes per 1000 patient-years. Regression analysis revealed increasing age, female sex and prior cerebrovascular disease were associated with dialysis withdrawal as a primary cause of death. Conversely, interstitial renal disease, angiographically proven ischaemic heart disease, valvular heart disease and malignancy were negatively associated. Analysis of free text comments revealed common themes, portraying an image of physical and psychological decline accelerated by acute illnesses.CONCLUSIONS: Death following dialysis withdrawal is common. Factors important to physical independence-prior cerebrovascular disease and increasing age-are associated with withdrawal. When combined with clinician comments this study provides an insight into the clinical decline affecting patients and the complexity of this decision. Early recognition of those likely to withdraw may improve end of life care.

    U2 - 10.1093/ndt/gfw074

    DO - 10.1093/ndt/gfw074

    M3 - Article

    VL - 31

    SP - 2041

    EP - 2048

    JO - Nephrology Dialysis Transplantation

    JF - Nephrology Dialysis Transplantation

    SN - 0931-0509

    IS - 12

    ER -

    Findlay MD, Donaldson K, Doyle A, Fox JG, Khan I, McDonald J et al. Factors influencing withdrawal from dialysis: a national registry study. Nephrology Dialysis Transplantation. 2016 Apr 21;31(12):2041-2048. https://doi.org/10.1093/ndt/gfw074