Factors Associated With Dialysis Withdrawal In Dialysis Patients

Abstract Background: Research on the factors associated with dialysis withdrawal in dialysis patients has been limited. Authors have used different definitions for dialysis withdrawal, resulting in inconsistent findings. The objective of this study was to determine the factors associated with dialysis withdrawal in dialysis patients.Methods: This retrospective study extracted patient information from the electronic renal patient management systems at the Grand River Hospital. A total of 723 patients who initiated renal dialysis therapy (> 30 days of duration) in the renal dialysis program at Grand River Hospital (GRH), Ontario, during the period from 1st January 2012 to 30th September 2017 were consecutively included in the study. Logistic regression was used to determine the factors: age, sex, modality, comorbidities, the cause of primary renal disease, dialysis modality, and duration of dialysis-associated with dialysis withdrawal. Dialysis withdrawal was defined as “patient declined further treatment or voluntary withdrawal from the dialysis program”.Results: The mean age of the sample was 64.86 ± 14.89 years, and 62.8% (n = 454) were males. The prevalence of dialysis withdrawal was 9.41% (n = 68). The logistic regression model showed that factors associated with dialysis withdrawal were as follows: cardiac disease [Adjusted Odds Ratio (AOR)= 1.921; 95% CI= 1.126–3.278], hypertension [AOR = 5.711; 95% CI = 1.322- 24.676], dementia [AOR = 3.042; 95% CI = 1.325–6.983], age [AOR = 1.035; 95% CI = 1.012– 1.058] and duration of dialysis [AOR = 0.999; 95% CI = 0.999–1.00].Conclusion: In this study we show that age, cardiac disease, hypertension, and dementia are significant predictors related to dialysis withdrawal. The findings might help in identifying patients who are more likely to withdraw from dialysis at the start of dialysis. Future researchers and nephrologists should design and conduct intervention studies focusing on strategies controlling the severity of comorbidities (cardiac disease and hypertension), regular assessment and monitoring of the progression of dementia, and other dialysis program changes to help patients make more informed decisions regarding dialysis withdrawal. Keywords: dialysis, dialysis withdrawal, maintenance dialysis, hemodialysis, peritoneal dialysis, dementia.