Document Detail

Early dialysis initiation and rates and timing of withdrawal from dialysis in Canada.
MedLine Citation:
PMID:  23085725     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND OBJECTIVES: The number of elderly patients and those with higher estimated GFR (eGFR) initiating dialysis have recently increased. This study sought to determine rates of withdrawal from dialysis and variables associated with withdrawal.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Canadian Organ Replacement Registry data were used to examine withdrawal rate and identify variables associated with withdrawal among the total cohort, patients age < 75 years, and patients age ≥ 75 years, along with those with early (eGFR > 10.5 ml/min per 1.73 m(2)) and those with late (eGFR ≤ 10.5 ml/min per 1.73 m(2)) initiation of dialysis, using a Cox proportional hazard model in patients starting dialysis between 2001 and 2009, with follow-up to December 31, 2009.
RESULTS: Median follow-up duration was 23.0 (interquartile range [IQR], 34.3) months. Rate of withdrawal per 100 patient-years doubled from 1.5 to 3.0, and withdrawal as cause of death increased from 7.9% to 19.5% between 2001 and 2009. Early initiation of dialysis was associated with increased withdrawal risk (hazard ratio, 1.17; 95% confidence interval, 1.06-1.30; P=0.002), as were older age, female sex, white race, and late referral to nephrologist. Patients age ≥ 75 years withdrew earlier after dialysis initiation (median, 15.9 [IQR, 27.9] months) compared to those age < 75 years (21.6 [IQR, 35.2] months). Early-start patients withdrew earlier (median, 15.6 [IQR, 28.5] months) compared with late-start patients (20.2 [IQR, 32.9] months).
CONCLUSIONS: In Canada, withdrawal from dialysis has increased significantly over recent years, especially among patients starting with higher eGFRs and in the elderly.
Amanda D Ellwood; S Vanita Jassal; Rita S Suri; William F Clark; Yingo Na; Louise M Moist
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Publication Detail:
Type:  Journal Article     Date:  2012-10-18
Journal Detail:
Title:  Clinical journal of the American Society of Nephrology : CJASN     Volume:  8     ISSN:  1555-905X     ISO Abbreviation:  Clin J Am Soc Nephrol     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-02-08     Completed Date:  2013-08-12     Revised Date:  2014-02-14    
Medline Journal Info:
Nlm Unique ID:  101271570     Medline TA:  Clin J Am Soc Nephrol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  265-70     Citation Subset:  IM    
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MeSH Terms
Age Factors
Early Medical Intervention / statistics & numerical data
Middle Aged
Renal Dialysis / statistics & numerical data*
Time Factors
Withholding Treatment / statistics & numerical data*
Comment In:
Clin J Am Soc Nephrol. 2013 Feb;8(2):179-81   [PMID:  23349332 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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