In the Journals

Medical complications, frailty may increase rate of withdrawal from hemodialysis before death

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.

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.