Recently published results showed medical complications and frailty may be driving factors for the high rate of hemodialysis withdrawals before death found in a single center.
Among 1,226 patients on incident hemodialysis from January 2001 to November 2013, researchers found 536 died. Of these patients, 49% withdrew from hemodialysis before death. In a random sample review of death notification forms, results showed withdrawal had a sensitivity of 73%. Researchers noted older age, white race, palliative care consultation within 6 months, hospitalization within 30 days, cerebrovascular disease and no coronary artery disease as risk factors for withdrawal of hemodialysis before death. According to results, 60% and 33% of withdrawal decisions were made by patients or family members, respectively, with 51% of patients withdrawing due to acute medical complications and 22% due to failure to thrive/frailty.
Results showed a median time to death of 7 days after withdrawal. Researchers found patients in the withdrawal group were less likely to experience in-hospital death. Among patients who withdrew from hemodialysis before death, 34% received palliative care services. Researchers noted an association between palliative care consultation with longer hemodialysis duration, hospitalization within 30 days of death and death in hospital. – by Casey Tingle
Disclosures: Hickson reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.